Organization
PH BALANCE THERAPEUTICS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRANDON ARTHUR PEREA-HICKAM PHD, BCBA, MFTC, ADD (CEO & FOUNDER)
(720) 410-4529
Entity
Organization
Contact information
Practice address
525 3RD AVE STE 211C, LONGMONT, CO 80501-5859
(720) 410-4529
Mailing address
954 5TH AVE, LONGMONT, CO 80501-5424
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
106H00000X
Marriage & Family Therapist
Primary
—
—
Other
Enumeration date
10/04/2023
Last updated
10/04/2023
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