Healthcare Provider Details

I. General information

NPI: 1649189150
Provider Name (Legal Business Name): BALLAST BEHAVIORAL HEALTH GROUP PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2026
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3051 KIRBY WHITTEN RD STE 5
BARTLETT TN
38134-2811
US

IV. Provider business mailing address

3051 KIRBY WHITTEN RD STE 5
BARTLETT TN
38134-2811
US

V. Phone/Fax

Practice location:
  • Phone: 901-440-0989
  • Fax:
Mailing address:
  • Phone: 901-440-0989
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. JESSE MALOTT
Title or Position: FOUNDING PARTNER
Credential: PSYD
Phone: 626-755-1933