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General NPI Number Information
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NPI Number | 1912409707
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Entity Type | Organization
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Legal Business Name | BALANCED LIFE PSYCHOLOGY, LLC
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Dates
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Enumeration Date | 03/07/2018
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Last Update Date | 09/02/2025
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Provider Practice Location Address
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Address Line | 18291 N PIMA RD STE 110
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City | SCOTTSDALE
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State | AZ
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Zip | 85255-5698
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Country | US
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Telephone | 480-485-4625
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 50384
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City | PHOENIX
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State | AZ
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Zip | 85076-0384
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Country | US
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Telephone | 602-796-7081
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Fax |
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Authorized Official
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Title or Position | PSYCHOLOGIST
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Name | DR. DIANA MEDINA
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Credential | PHD
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Telephone | 480-485-4625
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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