Sierra Bales, LADC

Key facts

NPI

1073255402

Entity type

Individual (NPI type 1)

Primary specialty

Addiction (Substance Use Disorder) Counselor 101YA0400X

License

305653 (MN)

Practice address

360 Pierce Ave Ste 206
North Mankato, MN 56003-2250

Phone

(507) 229-0350

Fax

(507) 216-0371

NPI assigned

Apr 7, 2022

Sex

Female

Sole proprietor

No

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Mankato Chemical Health, LLC Addiction (Substance Use Disorder) Counselor · North Mankato, MN · NPI 1124684907
  NPD (past) ADDICTION (SUBSTANCE USE DISORDER)

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

No

State licenses

Practice roles

Specialties & licenses

Addresses

Other identifiers

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Apr 7, 2022.

{
    "created_epoch": "1649289600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1649289600000",
    "number": "1073255402",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "360 PIERCE AVE STE 206",
            "city": "NORTH MANKATO",
            "state": "MN",
            "postal_code": "560032250",
            "telephone_number": "507-229-0350",
            "fax_number": "507-216-0371"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "360 PIERCE AVE STE 206",
            "city": "NORTH MANKATO",
            "state": "MN",
            "postal_code": "560032250",
            "telephone_number": "507-229-0350",
            "fax_number": "507-216-0371"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BALES",
        "first_name": "SIERRA",
        "credential": "LADC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-04-07",
        "last_updated": "2022-04-07",
        "certification_date": "2022-04-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "MN",
            "license": "305653",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LADC LICENSE",
            "identifier": "305653",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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