Healthcare Provider Details

I. General information

NPI: 1366211971
Provider Name (Legal Business Name): BALANCED MENTAL HEALTH OF ARIZONA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/22/2023
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14122 W MCDOWELL RD STE 203
GOODYEAR AZ
85395-2505
US

IV. Provider business mailing address

14122 W MCDOWELL RD STE 203
GOODYEAR AZ
85395-2505
US

V. Phone/Fax

Practice location:
  • Phone: 623-349-1711
  • Fax: 623-399-1958
Mailing address:
  • Phone: 623-349-1711
  • Fax: 623-399-1958

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER JANE PETERSON
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: PMHNP-BC
Phone: 623-205-3505