Provider Demographics
NPI:1124648506
Name:BALES, STEPHANIE (LPC)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:BALES
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 LONGWOOD PL
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:AL
Mailing Address - Zip Code:35504-7231
Mailing Address - Country:US
Mailing Address - Phone:205-512-1069
Mailing Address - Fax:205-512-1069
Practice Address - Street 1:15 LONGWOOD PL
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:AL
Practice Address - Zip Code:35504-7231
Practice Address - Country:US
Practice Address - Phone:205-512-1069
Practice Address - Fax:256-796-7213
Is Sole Proprietor?:No
Enumeration Date:2020-04-25
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1990101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL284305Medicaid
AL268301Medicaid