Basic Information
| Provider Information | |||||||||
| NPI: | 1457734022 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BALETO | ||||||||
| FirstName: | JESSE | ||||||||
| MiddleName: | UNSIOG | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | MSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 244 N. MARINE CORPS. DRIVE | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | TAMUNING | ||||||||
| State: | GU | ||||||||
| PostalCode: | 96913 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6716466956 | ||||||||
| FaxNumber: | 6716473541 | ||||||||
| Practice Location | |||||||||
| Address1: | 1244 N MARINE CORPS DR | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | TAMUNING | ||||||||
| State: | GU | ||||||||
| PostalCode: | 969134308 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6716478262 | ||||||||
| FaxNumber: | 6716478257 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/01/2015 | ||||||||
| LastUpdateDate: | 07/01/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | IMF-140 | GU | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.