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General NPI Number Information
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NPI Number | 1700119989
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Entity Type | Organization
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Legal Business Name | KATHY BALLARD BEHAVIORAL HEALTH SERVICES LLC
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Dates
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Enumeration Date | 09/06/2009
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Last Update Date | 10/29/2009
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Provider Practice Location Address
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Address Line | 405 NEWBERRY AVENUE
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City | NEWBERRY
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State | MI
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Zip | 49868
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Country | US
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Telephone | 906-293-1982
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Fax | 906-293-1982
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Provider Business Mailing Address
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Address Line | PO BOX 44 405 NEWBERRY AVENUE
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City | NEWBERRY
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State | MI
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Zip | 49868
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Country | US
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Telephone | 906-293-1982
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Fax | 906-293-1982
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Authorized Official
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Title or Position | SOLE PROPRIETOR
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Name | KATHY R BALLARD
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Credential | ACSW LLC
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Telephone | 906-293-1982
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 6801059263
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License Number State | MI
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