Individual
RICHARD MELVIN BALABAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
101 W KIRKWOOD AVE, SUITE 213, BLOOMINGTON, IN 47404-6129
(812) 332-9200
(812) 334-2522
Mailing address
101 W. KIRKWOOD AVE, SUITE 213, BLOOMINGTON, IN 47404-6134
(812) 332-9200
(812) 334-2522
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
20010327
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000235771
ANTHEM
IN
Enumeration date
11/10/2005
Last updated
10/30/2007
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