Life Balance Clinic LLC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

C6582 Issued in MS

Legal business name

LIFE BALANCE CLINIC LLC

Practice address

1107 Openwood St
Vicksburg, MS 39183

Phone

(601) 831-4402

Fax

(601) 206-0672

NPI assigned

Aug 9, 2012

Organization subpart

No

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

Authorized official

Name

Dr. Annette Bryant, PHD-ABD, LCSWNPI 1407878663

Title

Owner/Provider

Phone

(601) 831-4402

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MS

Enrollment records 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
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1344470400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1533600000000",
    "number": "1811244858",
    "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": "601-206-0672"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1107 OPENWOOD ST",
            "city": "VICKSBURG",
            "state": "MS",
            "postal_code": "39183",
            "telephone_number": "601-831-4402",
            "fax_number": "601-206-0672"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFE BALANCE CLINIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-08-09",
        "last_updated": "2018-08-07",
        "status": "A",
        "authorized_official_last_name": "BRYANT",
        "authorized_official_first_name": "ANNETTE",
        "authorized_official_title_or_position": "OWNER/PROVIDER",
        "authorized_official_telephone_number": "601-831-4402",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHD-ABD, LCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": "MS",
            "license": "C6582",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Millicent Ledbetter
• David Cooper Lee, BC-HIS
• Karen Lee
• Stacy Leist
• Patricia Ann Lewis, PA-C
• Lincare Inc
• Lincare Inc.
• Linda Sweezer Enterprises, LLC
• Michael Lindsey
• Khelli Ameke Lockridge, DNP, FNP-C

• Clinical Social Worker in Vicksburg, MS
• Providers in Vicksburg, MS by specialty
• Clinical Social Worker in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 7, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.