Healthcare Provider Details

I. General information

NPI: 1356274344
Provider Name (Legal Business Name): BRIDGE TO BALANCE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2026
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1222 E BASELINE RD STE 103
TEMPE AZ
85283-1433
US

IV. Provider business mailing address

1222 E BASELINE RD STE 103
TEMPE AZ
85283-1433
US

V. Phone/Fax

Practice location:
  • Phone: 602-804-1182
  • Fax:
Mailing address:
  • Phone: 602-804-1182
  • Fax: 602-804-1182

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name: MYRIO MARTELL DAVIS
Title or Position: CEO
Credential:
Phone: 602-804-1182