Healthcare Provider Details

I. General information

NPI: 1265379952
Provider Name (Legal Business Name): COURTNEY CALLAWAY BALL LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/30/2026
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2501 PARKVIEW DR STE 230
FORT WORTH TX
76102-5855
US

IV. Provider business mailing address

2612 MEADOW GRN
BEDFORD TX
76021-4924
US

V. Phone/Fax

Practice location:
  • Phone: 214-699-6858
  • Fax:
Mailing address:
  • Phone: 214-699-6858
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number72688
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: