Provider Demographics
NPI:1083854962
Name:BALADY, TERRI MARIE
Entity Type:Individual
Prefix:MS
First Name:TERRI
Middle Name:MARIE
Last Name:BALADY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20356 SUPERIOR ST
Mailing Address - Street 2:
Mailing Address - City:CHATSWORTH
Mailing Address - State:CA
Mailing Address - Zip Code:91311-5374
Mailing Address - Country:US
Mailing Address - Phone:818-998-8446
Mailing Address - Fax:
Practice Address - Street 1:19231 VICTORY BLVD STE 554
Practice Address - Street 2:
Practice Address - City:RESEDA
Practice Address - State:CA
Practice Address - Zip Code:91335-6373
Practice Address - Country:US
Practice Address - Phone:818-775-1776
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-04
Last Update Date:2009-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA196856000Medicaid