Healthcare Provider Details

I. General information

NPI: 1720693062
Provider Name (Legal Business Name): INNER BALANCE COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2020
Last Update Date: 03/11/2025
Certification Date: 03/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1234 S POWER RD STE 252
MESA AZ
85206-3700
US

IV. Provider business mailing address

1234 S POWER RD STE 252
MESA AZ
85206-3700
US

V. Phone/Fax

Practice location:
  • Phone: 480-675-6185
  • Fax:
Mailing address:
  • Phone: 480-675-6185
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name: KATHERINE KANDARIS
Title or Position: OWNER
Credential: LPC
Phone: 602-675-6185