MEDICARE: MRS. MARIA DANIELLE PRIMM-BALLARD LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	68390	TX

General Provider Information

NPI Number	:	1134654205
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARIA DANIELLE PRIMM-BALLARD LPC

Provider Business Mailing Address
First Line	:	13131 FEATHER RIDGE DR
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78233-4526
Country	:	US
Telephone Number	:	210-823-7931
Fax Number	:

Provider Business Practice Location Address
First Line	:	13131 FEATHER RIDGE DR
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78233-4526
Country	:	US
Telephone Number	:	210-823-7931
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/26/2017
Last Update Date	:	04/26/2017

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