Provider Demographics
NPI:1891049458
Name:BALLI, MICHAEL ROJAS (WA STATE SUDP)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:ROJAS
Last Name:BALLI
Suffix:
Gender:M
Credentials:WA STATE SUDP
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 950
Mailing Address - Street 2:
Mailing Address - City:WENATCHEE
Mailing Address - State:WA
Mailing Address - Zip Code:98807
Mailing Address - Country:US
Mailing Address - Phone:509-662-9673
Mailing Address - Fax:509-662-9441
Practice Address - Street 1:327 OKANOGAN AVE
Practice Address - Street 2:
Practice Address - City:WENATCHEE
Practice Address - State:WA
Practice Address - Zip Code:98801
Practice Address - Country:US
Practice Address - Phone:509-662-9673
Practice Address - Fax:509-662-9441
Is Sole Proprietor?:No
Enumeration Date:2012-11-05
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACO 60153767101YA0400X
WA1891049458101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WACO 60153767Other101YA0400X - COUNSELOR - ADDICTION (SUBSTANCE USE DISORDER)