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NPI Code Detail

MEDICARE: MICHELLE L BALES PSY.D.

MEDICARE:   MICHELLE L BALES  PSY.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TC0700XClinical Psychologist33147CA
2103T00000XPsychologist33147CA

General Provider Information

NPI Number : 1427274562
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHELLE L BALES PSY.D.
Provider Business Mailing Address
First Line : 409 CAMINO DEL RIO S STE 310
Second Line :
City : SAN DIEGO
State : CA
Zip : 92108-3560
Country : US
Telephone Number : 877-404-1967
Fax Number :
Provider Business Practice Location Address
First Line : 409 CAMINO DEL RIO S STE 310
Second Line :
City : SAN DIEGO
State : CA
Zip : 92108-3560
Country : US
Telephone Number : 877-404-1967
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/17/2007
Last Update Date : 12/23/2022

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