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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