Provider Demographics
NPI:1538477500
Name:LIFE BALANCE NORTHWEST, LLC
Entity type:Organization
Organization Name:LIFE BALANCE NORTHWEST, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIST
Authorized Official - Prefix:
Authorized Official - First Name:ANN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:CHILDERS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:503-344-6211
Mailing Address - Street 1:333 S STATE ST V137
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97034-5052
Mailing Address - Country:US
Mailing Address - Phone:503-344-6211
Mailing Address - Fax:503-344-6991
Practice Address - Street 1:1595 HOLLY ST
Practice Address - Street 2:
Practice Address - City:WEST LINN
Practice Address - State:OR
Practice Address - Zip Code:97068-3326
Practice Address - Country:US
Practice Address - Phone:503-344-6211
Practice Address - Fax:503-344-6991
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-23
Last Update Date:2016-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD194932084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Single Specialty