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General NPI Number Information
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NPI Number | 1366352189
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Entity Type | Organization
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Legal Business Name | LUTISSUA D BALLARD, PSYD PLLC
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Dates
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Enumeration Date | 09/11/2026
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Last Update Date | 09/11/2026
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Provider Practice Location Address
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Address Line | 210 W CONTINENTAL RD STE 299
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City | GREEN VALLEY
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State | AZ
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Zip | 85622-3595
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Country | US
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Telephone | 520-329-1579
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 204
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City | FORT MILL
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State | SC
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Zip | 29716-0204
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Country | US
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Telephone | 520-329-1579
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Fax |
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Authorized Official
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Title or Position | OWNER/CLINICAL PSYCHOLOGIST
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Name | DR. LUTISSUA D BALLARD
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Credential | PSYD
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Telephone | 520-329-1579
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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