| Ph Balance Therapeutics | |
|
525 3rd Ave Ste 211c Longmont CO 80501-5859 | |
| (720) 410-4529 | |
| Not Available |
| Full Name | Ph Balance Therapeutics |
|---|---|
| Speciality | Marriage & Family Therapist |
| Location | 525 3rd Ave Ste 211c, Longmont, Colorado |
| Authorized Official Name and Position | Brandon Arthur Perea-hickam (CEO & FOUNDER) |
| Authorized Official Contact | 7204104529 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Ph Balance Therapeutics 954 5th Ave Longmont CO 80501-5424 Ph: () - | Ph Balance Therapeutics 525 3rd Ave Ste 211c Longmont CO 80501-5859 Ph: (720) 410-4529 |
| NPI Number | 1467232660 |
|---|---|
| Provider Enumeration Date | 10/04/2023 |
| Last Update Date | 10/04/2023 |
| Certification Date | 10/04/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1467232660 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | (* (Not Available)) | Secondary |
| 106H00000X | Marriage & Family Therapist | (* (Not Available)) | Primary |
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