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Organization
THE LIFE BALANCE CLINIC, BEHAVIORAL HEALTH SERVICE
Active
Organization
THE LIFE BALANCE CLINIC, BEHAVIORAL HEALTH SERVICE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. ANNETTE BRYANT LCSW-BCD (OWNER)
(601) 831-4402
Entity
Organization
Contact information
Practice address
1107 B OPENWOOD ST., VICKSBURG, MS 39183
(601) 831-4402
(601) 262-7226
Mailing address
113 WOODSTONE DR, VICKSBURG, MS 39183-8319
(601) 831-4402
(601) 262-7226
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
C6582
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
08000025
—
MS
Enumeration date
06/27/2011
Last updated
06/27/2011
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