Healthcare Provider Details

I. General information

NPI: 1205489432
Provider Name (Legal Business Name): RACHEL BALL PPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2019
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4025 RAWLINS ST
CHEYENNE WY
82001-1900
US

IV. Provider business mailing address

4025 RAWLINS ST
CHEYENNE WY
82001-1900
US

V. Phone/Fax

Practice location:
  • Phone: 307-426-4797
  • Fax:
Mailing address:
  • Phone: 307-426-4797
  • Fax: 307-426-4799

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number1418
License Number StateWY
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: