Provider Demographics
NPI:1619771276
Name:LIFEBALANCE BEHAVIORAL HEALTH, PLLC
Entity type:Organization
Organization Name:LIFEBALANCE BEHAVIORAL HEALTH, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:ELLEN
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, LPCC
Authorized Official - Phone:701-793-0798
Mailing Address - Street 1:1655 43RD ST S STE 205
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-3583
Mailing Address - Country:US
Mailing Address - Phone:701-793-0798
Mailing Address - Fax:
Practice Address - Street 1:1655 43RD ST S STE 205
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-3583
Practice Address - Country:US
Practice Address - Phone:701-793-0798
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-02
Last Update Date:2025-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health