Healthcare Provider Details

I. General information

NPI: 1588217251
Provider Name (Legal Business Name): NICOLE BALL COUNSELING, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2019
Last Update Date: 07/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1844 OAK HOLLOW DR STE B
TRAVERSE CITY MI
49686-5924
US

IV. Provider business mailing address

1844 OAK HOLLOW DR STE B
TRAVERSE CITY MI
49686-5924
US

V. Phone/Fax

Practice location:
  • Phone: 231-714-0282
  • Fax:
Mailing address:
  • Phone: 231-714-0282
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: NICOLE BALL
Title or Position: OWNER
Credential: MSW
Phone: 231-714-0282