Provider Demographics
NPI:1437960739
Name:YOUR LIFE IN BALANCE, LLC
Entity type:Organization
Organization Name:YOUR LIFE IN BALANCE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TONYA
Authorized Official - Middle Name:
Authorized Official - Last Name:KLEIN-JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-794-9724
Mailing Address - Street 1:2910 CHARLES ST
Mailing Address - Street 2:
Mailing Address - City:WELLSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26070-1032
Mailing Address - Country:US
Mailing Address - Phone:304-794-9724
Mailing Address - Fax:
Practice Address - Street 1:5021 NORTHFIELD DR
Practice Address - Street 2:
Practice Address - City:GIBSONIA
Practice Address - State:PA
Practice Address - Zip Code:15044-8003
Practice Address - Country:US
Practice Address - Phone:304-215-1122
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-15
Last Update Date:2025-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty