Organization
BALANCE FOR HEALTHY LIVING, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TIRZAH D JACOB (PRACTICE OWNER)
(503) 407-9232
Entity
Organization
Contact information
Practice address
6129 NE SKIDMORE ST, PORTLAND, OR 97218-2227
(503) 407-9232
Mailing address
6129 NE SKIDMORE ST, PORTLAND, OR 97218-2227
(503) 407-9232
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
C1780
OR
101YM0800X
Mental Health Counselor
C1780
OR
101YP2500X
Professional Counselor
Primary
C1780
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11607801
CAQH
OR
05
—
500601179
—
OR
Enumeration date
09/14/2010
Last updated
06/01/2023
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