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General NPI Number Information
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NPI Number | 1609317791
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Entity Type | Organization
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Legal Business Name | AZ BALANCED LIVING SOLUTIONS, LLC
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Dates
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Enumeration Date | 03/09/2017
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Last Update Date | 03/09/2017
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Provider Practice Location Address
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Address Line | 17505 N 79TH AVE SUITE 305-C
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City | GLENDALE
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State | AZ
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Zip | 85308-8725
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Country | US
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Telephone | 623-777-9211
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 742
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City | TOLLESON
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State | AZ
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Zip | 85353-0742
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Country | US
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Telephone | 623-777-9211
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | WENDY ANN WHITSETT
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Credential | MC
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Telephone | 623-777-9211
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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 |
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License Number State |
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