Healthcare Provider Details

I. General information

NPI: 1174290761
Provider Name (Legal Business Name): MRS. RACHEL LYNNE BALLARD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RACHEL LYNNE O'NEAL

II. Dates (important events)

Enumeration Date: 08/23/2021
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3067 E WARM SPRINGS RD STE 100
LAS VEGAS NV
89120-3750
US

IV. Provider business mailing address

1513 TANGLEWOOD DR
LAFAYETTE IN
47905-4114
US

V. Phone/Fax

Practice location:
  • Phone: 702-710-0000
  • Fax:
Mailing address:
  • Phone: 765-418-7272
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number20043921B
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberPI028
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: