Provider Demographics
NPI:1588798136
Name:BALES, ALPHA WARREN (LSCSW)
Entity Type:Individual
Prefix:
First Name:ALPHA
Middle Name:WARREN
Last Name:BALES
Suffix:
Gender:M
Credentials:LSCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 SW CLONTARF ST
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66611-2420
Mailing Address - Country:US
Mailing Address - Phone:785-267-4740
Mailing Address - Fax:
Practice Address - Street 1:909 S 2ND ST
Practice Address - Street 2:
Practice Address - City:HIAWATHA
Practice Address - State:KS
Practice Address - Zip Code:66434-2774
Practice Address - Country:US
Practice Address - Phone:785-742-7113
Practice Address - Fax:785-742-3085
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2012-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS40511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100097950AMedicaid
KS200434510AMedicaid
KS100097950AMedicaid