Provider Demographics
NPI:1881721777
Name:BALA, MICHAEL (MFT)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:
Last Name:BALA
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:483 MARIETTA DR
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94127-1819
Mailing Address - Country:US
Mailing Address - Phone:415-203-4440
Mailing Address - Fax:415-585-0245
Practice Address - Street 1:4326 18TH ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94114-2427
Practice Address - Country:US
Practice Address - Phone:415-626-3035
Practice Address - Fax:415-585-0245
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC36374106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist