# PH BALANCE BEHAVIORAL

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

## Provider details

- **NPI number:** 1598399115
- **Authorized official:** DR. BRANDON ARTHUR PEREA-HICKAM PHD, BCBA (FOUNDER AND CEO)
- **Authorized official phone:** (720) 410-4529

## Contact information

- **Practice address:** 954 5TH AVE, LONGMONT, CO 80501-5424
- **Practice address phone:** (720) 410-4529
- **Mailing address:** 954 5TH AVE, LONGMONT, CO 80501-5424
- **Mailing address phone:** (720) 410-4529

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 103K00000X | Behavior Analyst | — | NULL | Yes |
| 103K00000X | Behavior Analyst | — | — | Yes |
| 103TB0200X | Cognitive & Behavioral Psychologist | — | NULL | — |
| 103TB0200X | Cognitive & Behavioral Psychologist | — | — | — |
| 103TH0100X | Health Service Psychologist | — | NULL | — |
| 103TH0100X | Health Service Psychologist | — | — | — |
| 106E00000X | Assistant Behavior Analyst | — | NULL | — |
| 106E00000X | Assistant Behavior Analyst | — | — | — |
| 106S00000X | Behavior Technician | — | NULL | — |
| 106S00000X | Behavior Technician | — | — | — |

## Other

- **Enumeration date:** 02/24/2020
- **Last updated:** 10/04/2023