| Organization Name: | BALANCED LIVING THERAPY, LLC |
| NPI Number: | 1063855609 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MAGGIE CATHERINE ISHAQ (OWNER/LICENSED MENTAL HEALTH COUNS) |
| Mailing Address: | 7631 212th St Sw Suite 108c Edmonds |
| State: | WA US |
| Postal Code: | 980267565 |
| Phone Number: | 4259774988 |
| Fax Number: | |
| NPI Enumeration Date: | 04/13/2013 |
| NPI Last Update Date: | 04/13/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | 603200357 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |