Provider Demographics
NPI:1285713578
Name:BALES, RACHAL I (MA, LMFT)
Entity type:Individual
Prefix:
First Name:RACHAL
Middle Name:I
Last Name:BALES
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3202 MCINTOSH CIRCLE DR
Mailing Address - Street 2:STE LL02
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64804-3646
Mailing Address - Country:US
Mailing Address - Phone:417-347-3508
Mailing Address - Fax:
Practice Address - Street 1:3202 MCINTOSH CIRCLE DR
Practice Address - Street 2:STE LL02
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-3646
Practice Address - Country:US
Practice Address - Phone:417-347-3508
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2010-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005001135106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO043585753OtherNEAS EAP