Organization
NEW LIFE BALANCE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHARLES MCCUSKER (REGISTERED AGENT)
(435) 695-4421
Entity
Organization
Contact information
Practice address
2689 S HIGHLAND DR, SALT LAKE CITY, UT 84106-2774
(435) 695-4421
(385) 259-0990
Mailing address
2689 S HIGHLAND DR, SALT LAKE CITY, UT 84106-2774
(435) 695-4421
(385) 259-0990
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
1160352501
UT
Other
Enumeration date
09/13/2012
Last updated
09/13/2012
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