Provider Demographics
NPI:1568731420
Name:BAL, CIARA JUSTINE
Entity Type:Individual
Prefix:
First Name:CIARA
Middle Name:JUSTINE
Last Name:BAL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6600 WESTOWN PKWY STE 240
Mailing Address - Street 2:
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50266-7714
Mailing Address - Country:US
Mailing Address - Phone:515-210-3354
Mailing Address - Fax:
Practice Address - Street 1:6600 WESTOWN PKWY STE 240
Practice Address - Street 2:
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266-7714
Practice Address - Country:US
Practice Address - Phone:515-210-3354
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-22
Last Update Date:2014-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA000349106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist