Provider Demographics
NPI:1730548066
Name:BALANCED LIFE WICHITA
Entity type:Organization
Organization Name:BALANCED LIFE WICHITA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:KEANE
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:316-494-3350
Mailing Address - Street 1:2020 N WOOD CT
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67212-5322
Mailing Address - Country:US
Mailing Address - Phone:316-494-3350
Mailing Address - Fax:
Practice Address - Street 1:2020 N WOOD CT
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67212-5322
Practice Address - Country:US
Practice Address - Phone:316-494-3350
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-15
Last Update Date:2016-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty