Healthcare Provider Details

I. General information

NPI: 1063070639
Provider Name (Legal Business Name): NATASHA LEE BALLARD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2019
Last Update Date: 09/18/2023
Certification Date: 09/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8301 PARC PLACE SUITE A
CHALMETTE LA
70043
US

IV. Provider business mailing address

8310 PARC PL STE A
CHALMETTE LA
70043-1646
US

V. Phone/Fax

Practice location:
  • Phone: 504-285-8009
  • Fax: 504-395-0267
Mailing address:
  • Phone: 504-285-8009
  • Fax: 504-395-0267

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number7259
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: