Provider Demographics
NPI:1427404763
Name:BALASINGHAM, NOEL RAJ (MA, LPC)
Entity Type:Individual
Prefix:
First Name:NOEL
Middle Name:RAJ
Last Name:BALASINGHAM
Suffix:
Gender:M
Credentials:MA, LPC
Other - Prefix:
Other - First Name:CONSCIOUS
Other - Middle Name:GRACE
Other - Last Name:THERAPY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:12335 HYMEADOW DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78750-1934
Mailing Address - Country:US
Mailing Address - Phone:512-541-8274
Mailing Address - Fax:
Practice Address - Street 1:12335 HYMEADOW DR
Practice Address - Street 2:SUITE 300
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78750-1934
Practice Address - Country:US
Practice Address - Phone:512-541-8274
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-05
Last Update Date:2016-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX72679101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health