# PH BALANCE THERAPEUTICS

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1467232660
- **Authorized official:** DR. BRANDON ARTHUR PEREA-HICKAM PHD, BCBA, MFTC, ADD (CEO & FOUNDER)
- **Authorized official phone:** (720) 410-4529

## Contact information

- **Practice address:** 525 3RD AVE STE 211C, LONGMONT, CO 80501-5859
- **Practice address phone:** (720) 410-4529
- **Mailing address:** 954 5TH AVE, LONGMONT, CO 80501-5424

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 101YA0400X | Addiction (Substance Use Disorder) Counselor | — | NULL | — |
| 101YA0400X | Addiction (Substance Use Disorder) Counselor | — | — | — |
| 106H00000X | Marriage & Family Therapist | — | NULL | Yes |
| 106H00000X | Marriage & Family Therapist | — | — | Yes |

## Other

- **Enumeration date:** 10/04/2023
- **Last updated:** 10/04/2023