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General NPI Number Information
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NPI Number | 1336457365
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Entity Type | Organization
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Legal Business Name | MY BALANCED LIFE, LLC
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Dates
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Enumeration Date | 09/24/2010
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Last Update Date | 09/24/2010
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Provider Practice Location Address
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Address Line | 2060 W WHISPERING WIND DR SUITE 264
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City | PHOENIX
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State | AZ
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Zip | 85085-2867
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Country | US
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Telephone | 623-551-4332
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Fax |
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Provider Business Mailing Address
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Address Line | 41556 N CLEAR CROSSING RD
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City | ANTHEM
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State | AZ
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Zip | 85086-1079
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Country | US
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Telephone | 623-551-4332
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Fax |
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Authorized Official
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Title or Position | LICENSED PROFESSIONAL COUNSELOR
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Name | KARI ANDERSON
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Credential | LPC
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Telephone | 623-551-4332
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LPC1674
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License Number State | AZ
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