Healthcare Provider Details

I. General information

NPI: 1861465817
Provider Name (Legal Business Name): LAWRENCE B BALL PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/09/2006
Last Update Date: 01/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 N LOUIS J KOCH BLVD # 203
SANTA CLAUS IN
47579-8540
US

IV. Provider business mailing address

PO BOX 719
SANTA CLAUS IN
47579-0719
US

V. Phone/Fax

Practice location:
  • Phone: 310-951-3894
  • Fax:
Mailing address:
  • Phone: 310-951-3894
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY18983
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number20042996A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: