MEDICARE: MRS. ALEXIS ROSE BALKEY

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
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1407981335
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ALEXIS ROSE BALKEY

Provider Business Mailing Address
First Line	:	66168 S AGUA DULCE DR
Second Line	:
City	:	DESERT HOT SPRINGS
State	:	CA
Zip	:	92240-8111
Country	:	US
Telephone Number	:	858-945-2539
Fax Number	:

Provider Business Practice Location Address
First Line	:	68100 RAMON RD
Second Line	:	B-10
City	:	CATHEDRAL CITY
State	:	CA
Zip	:	92234-3387
Country	:	US
Telephone Number	:	760-321-0870
Fax Number	:	760-321-0916

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/22/2007
Last Update Date	:	01/05/2009

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