MEDICARE: KELSEY BALABAN LCSW

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	1041C0700X	Clinical Social Worker	63067	TX

General Provider Information

NPI Number	:	1790346740
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELSEY BALABAN LCSW

Provider Business Mailing Address
First Line	:	8956 RESEARCH BLVD BLDG 2
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78758-5945
Country	:	US
Telephone Number	:	512-451-7337
Fax Number	:	512-451-8729

Provider Business Practice Location Address
First Line	:	8956 RESEARCH BLVD BLDG 2
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78758-5945
Country	:	US
Telephone Number	:	512-451-7337
Fax Number	:	512-451-8729

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

Provider Enumeration Date	:	06/20/2019
Last Update Date	:	06/20/2019

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Directions to “ KELSEY BALABAN LCSW” Practice Location

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