Provider Demographics
NPI:1184643033
Name:BALBERG, STEPHEN JAY (MS)
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:JAY
Last Name:BALBERG
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:807 W 7TH AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99204-2808
Mailing Address - Country:US
Mailing Address - Phone:509-455-7654
Mailing Address - Fax:
Practice Address - Street 1:807 W 7TH AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204-2808
Practice Address - Country:US
Practice Address - Phone:509-455-7654
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALF00001084106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist