Healthcare Provider Details

I. General information

NPI: 1841287885
Provider Name (Legal Business Name): BALLAINE PSYCHOLOGICAL SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2005
Last Update Date: 12/28/2020
Certification Date: 12/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1040 MEADOW MOUSE RD
FAIRBANKS AK
99709-6618
US

IV. Provider business mailing address

1040 MEADOW MOUSE RD
FAIRBANKS AK
99709-6618
US

V. Phone/Fax

Practice location:
  • Phone: 907-479-8933
  • Fax: 907-479-8934
Mailing address:
  • Phone: 907-479-8933
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: MS. KORNELIA GRABINSKA
Title or Position: PRESIDENT
Credential: PHD
Phone: 907-479-8933