Provider Demographics
NPI:1770158271
Name:BALACI, ANAIS MARIA (LAC)
Entity type:Individual
Prefix:
First Name:ANAIS
Middle Name:MARIA
Last Name:BALACI
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18178 W VIA MONTOYA DR
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85387-1543
Mailing Address - Country:US
Mailing Address - Phone:623-313-7082
Mailing Address - Fax:
Practice Address - Street 1:12211 W BELL RD STE 205
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85378-9522
Practice Address - Country:US
Practice Address - Phone:623-977-0677
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-26
Last Update Date:2021-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ19619101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health