Provider Demographics
NPI:1871752691
Name:BALE, PATRICIA LYNN (PHD)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:LYNN
Last Name:BALE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1430 SUNDANCE AVE
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:CA
Mailing Address - Zip Code:92078-7999
Mailing Address - Country:US
Mailing Address - Phone:760-445-9208
Mailing Address - Fax:
Practice Address - Street 1:374 N COAST HIGHWAY 101
Practice Address - Street 2:SUITE F
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-2542
Practice Address - Country:US
Practice Address - Phone:760-445-9208
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-06
Last Update Date:2008-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 19817103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical