Provider Demographics
NPI:1720372774
Name:BALICKI, DAVID SHAWN (LMFT)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:SHAWN
Last Name:BALICKI
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1922 THE ALAMEDA
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95126-1457
Mailing Address - Country:US
Mailing Address - Phone:408-483-0439
Mailing Address - Fax:
Practice Address - Street 1:96 S 14TH ST
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95112-2015
Practice Address - Country:US
Practice Address - Phone:408-261-7777
Practice Address - Fax:408-642-6052
Is Sole Proprietor?:No
Enumeration Date:2011-06-07
Last Update Date:2025-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA87584106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist