Basic Information
| Provider Information | |||||||||
| NPI: | 1376878520 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BALES | ||||||||
| FirstName: | KATHY | ||||||||
| MiddleName: | RICHELLE | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2700 FARMINGTON AVE | ||||||||
| Address2: | BLDG., F STE. 1 | ||||||||
| City: | FARMINGTON | ||||||||
| State: | NM | ||||||||
| PostalCode: | 874014559 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5053267878 | ||||||||
| FaxNumber: | 5053267879 | ||||||||
| Practice Location | |||||||||
| Address1: | 2700 FARMINGTON AVE | ||||||||
| Address2: | BLDG., F STE. 1 | ||||||||
| City: | FARMINGTON | ||||||||
| State: | NM | ||||||||
| PostalCode: | 874014559 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5053267878 | ||||||||
| FaxNumber: | 5053267879 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/06/2009 | ||||||||
| LastUpdateDate: | 10/06/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.