Provider Demographics
NPI:1356199822
Name:BALADEZ, AMBER NICOLE SR
Entity type:Individual
Prefix:MRS
First Name:AMBER
Middle Name:NICOLE
Last Name:BALADEZ
Suffix:SR
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:AMBER
Other - Middle Name:NICOLE
Other - Last Name:BALCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:823 N VILLA AVE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73107-6439
Mailing Address - Country:US
Mailing Address - Phone:405-772-9337
Mailing Address - Fax:
Practice Address - Street 1:823 N VILLA AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73107-6439
Practice Address - Country:US
Practice Address - Phone:405-772-9337
Practice Address - Fax:000-000-0000
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-09
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)