Organization
BALES PSYCHOLOGY CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHAMIRON BALES PH.D. (OWNER)
(619) 599-6797
Entity
Organization
Contact information
Practice address
3252 HOLIDAY CT STE 114, LA JOLLA, CA 92037-0027
(619) 380-0508
Mailing address
3252 HOLIDAY CT STE 114, LA JOLLA, CA 92037-0027
(619) 380-0508
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
—
—
103TC0700X
Clinical Psychologist
Primary
—
—
103TC2200X
Clinical Child & Adolescent Psychologist
—
—
103TM1800X
Intellectual & Developmental Disabilities Psychologist
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
261QM0850X
Adult Mental Health Clinic/Center
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1962266973
103T00000X
CA
Enumeration date
05/06/2024
Last updated
02/19/2025
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