Provider Demographics
NPI:1780825141
Name:BALSAM, YAFFA (LMFT)
Entity Type:Individual
Prefix:MS
First Name:YAFFA
Middle Name:
Last Name:BALSAM
Suffix:
Gender:F
Credentials:LMFT
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 2481
Mailing Address - Street 2:
Mailing Address - City:LOS ALAMITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90720-7481
Mailing Address - Country:US
Mailing Address - Phone:714-527-8111
Mailing Address - Fax:
Practice Address - Street 1:4050 KATELLA AVE
Practice Address - Street 2:#211
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720-3434
Practice Address - Country:US
Practice Address - Phone:714-527-8111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-16
Last Update Date:2009-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC25307106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist