Provider Demographics
NPI:1376878520
Name:BALES, KATHY RICHELLE (MA)
Entity Type:Individual
Prefix:MRS
First Name:KATHY
Middle Name:RICHELLE
Last Name:BALES
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2700 FARMINGTON AVE
Mailing Address - Street 2:BLDG., F STE. 1
Mailing Address - City:FARMINGTON
Mailing Address - State:NM
Mailing Address - Zip Code:87401-4559
Mailing Address - Country:US
Mailing Address - Phone:505-326-7878
Mailing Address - Fax:505-326-7879
Practice Address - Street 1:2700 FARMINGTON AVE
Practice Address - Street 2:BLDG., F STE. 1
Practice Address - City:FARMINGTON
Practice Address - State:NM
Practice Address - Zip Code:87401-4559
Practice Address - Country:US
Practice Address - Phone:505-326-7878
Practice Address - Fax:505-326-7879
Is Sole Proprietor?:No
Enumeration Date:2009-10-06
Last Update Date:2009-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional