Provider Demographics
NPI:1386161354
Name:HESTER BALSAM, MSW, LCSW, LLC
Entity type:Organization
Organization Name:HESTER BALSAM, MSW, LCSW, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HESTER
Authorized Official - Middle Name:
Authorized Official - Last Name:BALSAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-899-1020
Mailing Address - Street 1:120 ORTEGA RD NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87113-1430
Mailing Address - Country:US
Mailing Address - Phone:505-899-1020
Mailing Address - Fax:
Practice Address - Street 1:120 ORTEGA RD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87113-1430
Practice Address - Country:US
Practice Address - Phone:505-899-1020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-29
Last Update Date:2017-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMI-05220261QM0801X
261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)