Provider Demographics
NPI:1184182032
Name:BALISI, MICHELLE E (MS, LMFT)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:E
Last Name:BALISI
Suffix:
Gender:F
Credentials:MS, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2386 FARADAY AVE STE 140
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92008-7222
Mailing Address - Country:US
Mailing Address - Phone:657-215-0909
Mailing Address - Fax:
Practice Address - Street 1:2386 FARADAY AVE STE 140
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92008-7222
Practice Address - Country:US
Practice Address - Phone:657-215-0909
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-11
Last Update Date:2020-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1336201490Medicaid