Provider Demographics
NPI:1649621046
Name:INTEGRATIVE BALANCE PSYCHOTHERAPY
Entity type:Organization
Organization Name:INTEGRATIVE BALANCE PSYCHOTHERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:WESLEY
Authorized Official - Middle Name:MARSHALL
Authorized Official - Last Name:BOWMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MSED, LPC
Authorized Official - Phone:970-238-0268
Mailing Address - Street 1:1182 GRAVES AVE UNIT C
Mailing Address - Street 2:SUITE #2
Mailing Address - City:ESTES PARK
Mailing Address - State:CO
Mailing Address - Zip Code:80517-7742
Mailing Address - Country:US
Mailing Address - Phone:970-238-0268
Mailing Address - Fax:970-692-2594
Practice Address - Street 1:1182 GRAVES AVE UNIT C
Practice Address - Street 2:SUITE #2
Practice Address - City:ESTES PARK
Practice Address - State:CO
Practice Address - Zip Code:80517-7742
Practice Address - Country:US
Practice Address - Phone:970-238-0268
Practice Address - Fax:970-692-2594
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-27
Last Update Date:2016-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPC.0012110101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty