Life Balance Medical Group LLC

Primary specialty

Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X

Legal business name

LIFE BALANCE MEDICAL GROUP LLC

Practice address

2916 W Waters Ave Ste A1
Tampa, FL 33614-1869

Phone

(813) 443-8221

Fax

(813) 443-1869

NPI assigned

Mar 17, 2020

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Pedro M Hernandez

Title

Owner

Phone

(813) 443-8221

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1584403200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1632182400000",
    "number": "1336775733",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 151686",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336841686",
            "telephone_number": "813-443-8221",
            "fax_number": "813-443-1869"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2916 W WATERS AVE STE A1",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336141869",
            "telephone_number": "813-443-8221",
            "fax_number": "813-443-1869"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFE BALANCE MEDICAL GROUP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-03-17",
        "last_updated": "2021-09-21",
        "certification_date": "2021-09-21",
        "status": "A",
        "authorized_official_last_name": "HERNANDEZ",
        "authorized_official_first_name": "PEDRO",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "813-443-8221"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Carol H Lieber, LCSW
• Abbey Rose Liebert
• David T. Liebert, ED.D.
• Cassidy N Liebler, APRN-C
• Ravy Lieng, LCSW
• Life Blessing Behavior Corp
• Life Cycles Guardianship Foundation, Inc.
• Life Extension Clinics, Inc
• Life Focus Group of Tampa Bay
• Life Long Home Care Corp

• Mental Health Clinic/Center (Including Community Mental Health Center) in Tampa, FL
• Providers in Tampa, FL by specialty
• Mental Health Clinic/Center (Including Community Mental Health Center) in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 21, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.