Provider Demographics
NPI:1538660428
Name:BALES, SARAH REBECCA (LCSW)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:REBECCA
Last Name:BALES
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1343
Mailing Address - Street 2:
Mailing Address - City:RATON
Mailing Address - State:NM
Mailing Address - Zip Code:87740-1343
Mailing Address - Country:US
Mailing Address - Phone:323-480-3710
Mailing Address - Fax:575-221-5561
Practice Address - Street 1:411 1/2 S 3RD ST
Practice Address - Street 2:
Practice Address - City:RATON
Practice Address - State:NM
Practice Address - Zip Code:87740
Practice Address - Country:US
Practice Address - Phone:575-303-2260
Practice Address - Fax:575-303-4624
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-26
Last Update Date:2021-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW-179131041C0700X
CALCSW-960251041C0700X
NMC-108341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical