Healthcare Provider Details

I. General information

NPI: 1366352189
Provider Name (Legal Business Name): LUTISSUA D BALLARD, PSYD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2026
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 W CONTINENTAL RD STE 299
GREEN VALLEY AZ
85622-3595
US

IV. Provider business mailing address

PO BOX 204
FORT MILL SC
29716-0204
US

V. Phone/Fax

Practice location:
  • Phone: 520-329-1579
  • Fax:
Mailing address:
  • Phone: 520-329-1579
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. LUTISSUA D BALLARD
Title or Position: OWNER/CLINICAL PSYCHOLOGIST
Credential: PSYD
Phone: 520-329-1579