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General NPI Number Information
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NPI Number | 1386415818
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Entity Type | Individual
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Provider Name | MATTHEW BALLI
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Gender | Male
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Dates
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Enumeration Date | 01/12/2024
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Last Update Date | 01/12/2024
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Provider Practice Location Address
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Address Line | 1805 CARI NICOLE AVE
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City | EDINBURG
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State | TX
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Zip | 78541-0548
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Country | US
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Telephone | 956-467-3408
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Fax |
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Provider Business Mailing Address
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Address Line | 1921 PELICAN AVE
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City | MCALLEN
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State | TX
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Zip | 78504-3815
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Country | US
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Telephone | 956-467-3408
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 90219
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License Number State | TX
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