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General NPI Number Information
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NPI Number | 1205404803
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Entity Type | Individual
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Provider Name | MICHAEL ALLEN BALSLEY MSW, LSW
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Gender | Male
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Dates
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Enumeration Date | 06/11/2021
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Last Update Date | 08/18/2022
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Provider Practice Location Address
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Address Line | 7211 N MAIN ST STE 5
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City | DAYTON
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State | OH
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Zip | 45415-2560
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Country | US
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Telephone | 937-791-1427
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Fax | 937-702-3187
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Provider Business Mailing Address
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Address Line | PO BOX 396
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City | SPRINGBORO
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State | OH
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Zip | 45066-0396
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | S.2106216
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License Number State | OH
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