NPIMap

Organization Active NPI

Balanced Mental Health of Arizona

  • Psychiatric/Mental Health Nurse Practitioner
  • Goodyear, AZ
National Provider Identifier
1366211971
Registry record updated Jun 2, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
Legal business name
BALANCED MENTAL HEALTH OF ARIZONA
Practice address
14122 W McDowell Rd Ste 203
Goodyear, AZ 85395-2505
Phone
(623) 349-1711
Fax
(623) 399-1958
NPI assigned
Dec 22, 2023
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 2, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Jennifer Jane Peterson, PMHNP-BCNPI 1427510437
Title
Chief Executive Officer
Phone
(623) 205-3505

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse PractitionerGroup: 193400000X SINGLE SPECIALTY GROUP 363LP0808X Primary

Addresses

Primary practice location

14122 W McDowell Rd Ste 203
Goodyear, AZ 85395-2505

Mailing address

14122 W McDowell Rd Ste 203
Goodyear, AZ 85395-2505
Phone (623) 349-1711

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240425000361 AZ Part B Supplier - Clinic/Group Practice 9436599412 Receives reassigned benefits from 5 practitioners
Practice locations: Goodyear, AZ; Phoenix, AZ

National Provider Directory

National Provider Directory

Locations

14122 W McDowell Rd
Ste 203
Goodyear, AZ 85395
Phone (623) 349-1711

9250 W Thomas Rd
Ste 100
Phoenix, AZ 85037
Phone (602) 610-1191

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1703203200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1780358400000",
    "number": "1366211971",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14122 W MCDOWELL RD STE 203",
            "city": "GOODYEAR",
            "state": "AZ",
            "postal_code": "853952505",
            "telephone_number": "623-349-1711",
            "fax_number": "623-399-1958"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14122 W MCDOWELL RD STE 203",
            "city": "GOODYEAR",
            "state": "AZ",
            "postal_code": "853952505",
            "telephone_number": "623-349-1711",
            "fax_number": "623-399-1958"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BALANCED MENTAL HEALTH OF ARIZONA",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-12-22",
        "last_updated": "2026-06-02",
        "certification_date": "2026-06-02",
        "status": "A",
        "authorized_official_last_name": "PETERSON",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_middle_name": "JANE",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "623-205-3505",
        "authorized_official_credential": "PMHNP-BC"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Goodyear, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 2, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.