MEDICARE: MS. KIMBERLY BALLEIN LMFT

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	LMFT10021	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	LMFT10021	OTHER	AZ	THERAPIST

General Provider Information

NPI Number	:	1528137189
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KIMBERLY BALLEIN LMFT

Provider Business Mailing Address
First Line	:	2017 N 7TH ST
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85006-2102
Country	:	US
Telephone Number	:	602-452-4684
Fax Number	:	602-358-0399

Provider Business Practice Location Address
First Line	:	7434 E STETSON DR
Second Line	:	SUITE 160
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85251-3525
Country	:	US
Telephone Number	:	480-994-8477
Fax Number	:	480-994-8083

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

Provider Enumeration Date	:	11/07/2006
Last Update Date	:	07/08/2007

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