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General NPI Number Information
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NPI Number | 1356382683
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Entity Type | Individual
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Provider Name | BERTA BALLI MSW, LCSW
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Gender | Female
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Dates
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Enumeration Date | 06/09/2006
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Last Update Date | 01/27/2020
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Provider Practice Location Address
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Address Line | 9600 VETERANS DR SW BLDG 4-243
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City | TACOMA
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State | WA
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Zip | 98493-1874
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Country | US
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Telephone | 253-585-3513
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Fax | 541-971-9807
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Provider Business Mailing Address
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Address Line | 9600 VETERANS DR SW BLDG 4-243
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City | TACOMA
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State | WA
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Zip | 98493-0003
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Country | US
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Telephone | 253-583-3513
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | RC00053006
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | L8665
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License Number State | OR
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