Healthcare Provider Details

I. General information

NPI: 1033828884
Provider Name (Legal Business Name): MRS. LISA KAY BALLINGER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2022
Last Update Date: 11/06/2024
Certification Date: 11/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23366 COMMERCE PARK STE 100B
BEACHWOOD OH
44122-5801
US

IV. Provider business mailing address

7185 HULLS CV
MENTOR OH
44060-5106
US

V. Phone/Fax

Practice location:
  • Phone: 216-292-2880
  • Fax:
Mailing address:
  • Phone: 440-488-6066
  • Fax: 440-953-6101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberI.2405962
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberS1700018-TRNE
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: