Provider Demographics
NPI:1548871965
Name:BALMER, DAVID (LCDC)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:BALMER
Suffix:
Gender:M
Credentials:LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1013 DELESANDRI LN
Mailing Address - Street 2:
Mailing Address - City:KEMAH
Mailing Address - State:TX
Mailing Address - Zip Code:77565-3142
Mailing Address - Country:US
Mailing Address - Phone:713-568-1210
Mailing Address - Fax:
Practice Address - Street 1:1013 DELESANDRI LN
Practice Address - Street 2:
Practice Address - City:KEMAH
Practice Address - State:TX
Practice Address - Zip Code:77565-3142
Practice Address - Country:US
Practice Address - Phone:713-568-1210
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-10
Last Update Date:2020-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14965101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)