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General NPI Number Information
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NPI Number | 1407440175
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Entity Type | Individual
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Provider Name | DAVID BALLARD MA, LAC, NCC
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Gender | Male
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Dates
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Enumeration Date | 02/23/2021
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Last Update Date | 02/23/2021
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Provider Practice Location Address
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Address Line | 18789 N REEMS RD STE 260
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City | SURPRISE
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State | AZ
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Zip | 85374-8648
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Country | US
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Telephone | 480-694-5707
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 21275
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City | WICKENBURG
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State | AZ
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Zip | 85358-6275
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Country | US
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Telephone | 480-694-5707
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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