Provider Demographics
NPI:1528137189
Name:BALLEIN, KIMBERLY (LMFT)
Entity type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:
Last Name:BALLEIN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2017 N 7TH ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85006-2102
Mailing Address - Country:US
Mailing Address - Phone:602-452-4684
Mailing Address - Fax:602-358-0399
Practice Address - Street 1:7434 E STETSON DR
Practice Address - Street 2:SUITE 160
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85251-3525
Practice Address - Country:US
Practice Address - Phone:480-994-8477
Practice Address - Fax:480-994-8083
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLMFT10021101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZLMFT10021OtherTHERAPIST