# THE LIFE BALANCE CLINIC, BEHAVIORAL HEALTH SERVICE

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1649566894
- **Authorized official:** MRS. ANNETTE BRYANT LCSW-BCD (OWNER)
- **Authorized official phone:** (601) 831-4402

## Contact information

- **Practice address:** 1107 B OPENWOOD ST., VICKSBURG, MS 39183
- **Practice address phone:** (601) 831-4402
- **Practice address fax:** (601) 262-7226
- **Mailing address:** 113 WOODSTONE DR, VICKSBURG, MS 39183-8319
- **Mailing address phone:** (601) 831-4402
- **Mailing address fax:** (601) 262-7226

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1041C0700X | Clinical Social Worker | C6582 | MS | Yes |

## Other

- **Enumeration date:** 06/27/2011
- **Last updated:** 06/27/2011

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 08000025 | — | MS |