The Life Balance Clinic, Behavioral Health Service

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

C6582 Issued in MS

Legal business name

THE LIFE BALANCE CLINIC, BEHAVIORAL HEALTH SERVICE

Practice address

1107 B Openwood St.
Vicksburg, MS 39183

Phone

(601) 831-4402

Fax

(601) 262-7226

NPI assigned

Jun 27, 2011

Organization subpart

No

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

Authorized official

Name

Mrs. Annette Bryant, LCSW-BCDNPI 1407878663

Title

Owner

Phone

(601) 831-4402

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Annette Bryant, LCSW

  • Clinical Social Worker
  • Vicksburg, MS
  • NPI 1407878663

  Clinical

  NPD (past) Authorized official

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

{
    "created_epoch": "1309132800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1309132800000",
    "number": "1649566894",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "113 WOODSTONE DR",
            "city": "VICKSBURG",
            "state": "MS",
            "postal_code": "391838319",
            "telephone_number": "601-831-4402",
            "fax_number": "601-262-7226"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1107 B OPENWOOD ST.",
            "city": "VICKSBURG",
            "state": "MS",
            "postal_code": "39183",
            "telephone_number": "601-831-4402",
            "fax_number": "601-262-7226"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE LIFE BALANCE CLINIC, BEHAVIORAL HEALTH SERVICE",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-06-27",
        "last_updated": "2011-06-27",
        "status": "A",
        "authorized_official_last_name": "BRYANT",
        "authorized_official_first_name": "ANNETTE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "601-831-4402",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "LCSW-BCD"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": "MS",
            "license": "C6582",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "08000025",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Brandon Blake Teller, FNP-C
• Linda S Tello, LMFT
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• The Bluffs Rehabilitation and Healthcare Center, LLC
• The Lauren Forte Hair Loss Replacement Center
• The Nordal Clinic, PA
• The Vision Clinic of Vicksburg LLC
• Jasmine Thedford-McIntyre
• Ann Garrison Thomas
• Charles Brent Thomas, DMD

• All providers in Vicksburg, MS
• Clinical Social Worker in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 27, 2011; 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.