Healthcare Provider Details

I. General information

NPI: 1255907903
Provider Name (Legal Business Name): LIVING AND BALANCE WELLNESS CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2021
Last Update Date: 10/02/2025
Certification Date: 10/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10000 N 31ST AVE STE C218
PHOENIX AZ
85051-9620
US

IV. Provider business mailing address

10000 N 31ST AVE STE C218
PHOENIX AZ
85051-9620
US

V. Phone/Fax

Practice location:
  • Phone: 602-314-6312
  • Fax: 602-926-8317
Mailing address:
  • Phone: 602-314-6312
  • Fax: 602-926-8317

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MARIE DAVIS
Title or Position: CEO
Credential:
Phone: 602-314-6312