Healthcare Provider Details

I. General information

NPI: 1003386210
Provider Name (Legal Business Name): KAIJA ROZE BALES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2018
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

626 E PINTO CT STE 153
GILBERT AZ
85296-2926
US

IV. Provider business mailing address

626 E PINTO CT STE 153
GILBERT AZ
85296-2926
US

V. Phone/Fax

Practice location:
  • Phone: 602-890-0218
  • Fax:
Mailing address:
  • Phone: 602-890-0218
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLAC-24358
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: