Provider Demographics
NPI:1902174949
Name:LIFE BALANCE THERAPY, LLC
Entity Type:Organization
Organization Name:LIFE BALANCE THERAPY, LLC
Other - Org Name:EBONY BAILEY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PSYCHOTHERAPY
Authorized Official - Prefix:
Authorized Official - First Name:EBONY
Authorized Official - Middle Name:
Authorized Official - Last Name:BAILEY
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPC-MHSP
Authorized Official - Phone:901-598-2431
Mailing Address - Street 1:313 LOONEY AVE
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38107-3790
Mailing Address - Country:US
Mailing Address - Phone:901-598-2431
Mailing Address - Fax:
Practice Address - Street 1:5865 RIDGEWAY CENTER PKWY STE 300
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38120-4014
Practice Address - Country:US
Practice Address - Phone:901-598-2431
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-06
Last Update Date:2022-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000002511251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN2511OtherINSTAMED