Provider Demographics
NPI:1154654069
Name:BALES, DAVID ROBERT (LMFT)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:ROBERT
Last Name:BALES
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1845 CHICAGO AVE STE B
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92507-2366
Mailing Address - Country:US
Mailing Address - Phone:951-465-3664
Mailing Address - Fax:888-542-4042
Practice Address - Street 1:11840 MAGNOLIA AVE STE C
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92503-4900
Practice Address - Country:US
Practice Address - Phone:951-465-3664
Practice Address - Fax:888-542-4042
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-09
Last Update Date:2021-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF 88722106H00000X
CA127648106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist