Provider Demographics
NPI:1578845392
Name:BALSTERS, JANIS R (LPC)
Entity Type:Individual
Prefix:MS
First Name:JANIS
Middle Name:R
Last Name:BALSTERS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:71832 S 313 RD
Mailing Address - Street 2:
Mailing Address - City:WAGONER
Mailing Address - State:OK
Mailing Address - Zip Code:74467-7295
Mailing Address - Country:US
Mailing Address - Phone:918-485-6654
Mailing Address - Fax:
Practice Address - Street 1:71832 S 313 RD
Practice Address - Street 2:
Practice Address - City:WAGONER
Practice Address - State:OK
Practice Address - Zip Code:74467-7295
Practice Address - Country:US
Practice Address - Phone:918-485-6654
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-19
Last Update Date:2011-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional