Provider Demographics
NPI:1174223754
Name:BALY, JOANN TEJUMOLA
Entity type:Individual
Prefix:
First Name:JOANN
Middle Name:TEJUMOLA
Last Name:BALY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3743 BRIDGEBLUFF LN
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77449-0166
Mailing Address - Country:US
Mailing Address - Phone:281-216-4586
Mailing Address - Fax:
Practice Address - Street 1:3743 BRIDGEBLUFF LN
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77449-0166
Practice Address - Country:US
Practice Address - Phone:281-216-4586
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-03
Last Update Date:2023-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX107400104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker