Basic Information
| Provider Information | |||||||||
| NPI: | 1619459757 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BALSBAUGH | ||||||||
| FirstName: | KASSI | ||||||||
| MiddleName: | |||||||||
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| Credential: | MA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12650 E BRIARWOOD AVE UNIT 207 | ||||||||
| Address2: | |||||||||
| City: | CENTENNIAL | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801126792 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7204700578 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 12650 E BRIARWOOD AVE UNIT 207 | ||||||||
| Address2: | |||||||||
| City: | CENTENNIAL | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801126792 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7204700578 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/05/2018 | ||||||||
| LastUpdateDate: | 04/08/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/08/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | 1-19-40208 | CO | Y | Behavioral Health & Social Service Providers | Behavioral Analyst | 106S00000X | RBT-17-39415 | CO | N |
No ID Information.