Provider Demographics
NPI:1508934571
Name:BALES, ELIZABETH (PLPC)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:BALES
Suffix:
Gender:F
Credentials:PLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2260 N GOLDEN AVE TRLR 66
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65803-2277
Mailing Address - Country:US
Mailing Address - Phone:417-350-0395
Mailing Address - Fax:417-881-2640
Practice Address - Street 1:1722 S GLENSTONE AVE STE TT
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-1517
Practice Address - Country:US
Practice Address - Phone:417-881-2848
Practice Address - Fax:417-881-2640
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006034078101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional