Healthcare Provider Details

I. General information

NPI: 1942987821
Provider Name (Legal Business Name): CORE BALANCE COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2023
Last Update Date: 06/30/2023
Certification Date: 06/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2509 S POWER RD STE 110
MESA AZ
85209-6696
US

IV. Provider business mailing address

2509 S POWER RD STE 110
MESA AZ
85209-6696
US

V. Phone/Fax

Practice location:
  • Phone: 480-590-4227
  • Fax:
Mailing address:
  • Phone: 480-590-4227
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: JULIA CRUZ SPAIN
Title or Position: SOLE MEMBER
Credential: LPC
Phone: 602-697-1023