Provider Demographics
NPI:1912409707
Name:BALANCED LIFE PSYCHOLOGY, LLC
Entity Type:Organization
Organization Name:BALANCED LIFE PSYCHOLOGY, LLC
Other - Org Name:DR. DIANA MILNER, PHD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:MILNER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:602-796-7081
Mailing Address - Street 1:PO BOX 50384
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85076-0384
Mailing Address - Country:US
Mailing Address - Phone:602-796-7081
Mailing Address - Fax:
Practice Address - Street 1:11011 S 48TH ST STE 200
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85044-1788
Practice Address - Country:US
Practice Address - Phone:602-796-7081
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-07
Last Update Date:2018-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4607103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty