Provider Demographics
NPI:1083724041
Name:BALOK-SEARLES, REBECCA M (MA LCMHC)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:M
Last Name:BALOK-SEARLES
Suffix:
Gender:F
Credentials:MA LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 LIMESTONE LN
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03867-2065
Mailing Address - Country:US
Mailing Address - Phone:603-749-1698
Mailing Address - Fax:
Practice Address - Street 1:10 2ND ST
Practice Address - Street 2:SUITE J
Practice Address - City:DOVER
Practice Address - State:NH
Practice Address - Zip Code:03820-3367
Practice Address - Country:US
Practice Address - Phone:603-749-1698
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NHNH-613101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NHPHCSOtherPRIVATE HEALTHCARE SYS
NH11564108OtherCAQH
NH14Y010412NH01OtherBHN ANTHEM BCBS
NH30424206Medicaid