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General NPI Number Information
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NPI Number | 1043140775
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Entity Type | Organization
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Legal Business Name | LIVING AND BALANCE WELLNESS CENTER LLC
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Dates
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Enumeration Date | 05/22/2026
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Last Update Date | 05/22/2026
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Provider Practice Location Address
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Address Line | 736 N COUNTRY CLUB DR STE 102
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City | MESA
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State | AZ
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Zip | 85201-4981
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Country | US
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Telephone | 602-314-6312
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Fax |
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Provider Business Mailing Address
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Address Line | 736 N COUNTRY CLUB DR STE 102
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City | MESA
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State | AZ
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Zip | 85201-4981
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MARIE DAVIS
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Credential |
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Telephone | 602-403-5160
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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