MEDICARE: KORTNEY BALL L.P.C., S.C.L.

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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1720765985
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KORTNEY BALL L.P.C., S.C.L.

Provider Business Mailing Address
First Line	:	5124 BIRCH AVE
Second Line	:
City	:	LEXINGTON
State	:	MI
Zip	:	48450-9261
Country	:	US
Telephone Number	:	810-300-9465
Fax Number	:

Provider Business Practice Location Address
First Line	:	7285 LAKESHORE RD
Second Line	:
City	:	LEXINGTON
State	:	MI
Zip	:	48450-9772
Country	:	US
Telephone Number	:	810-300-9465
Fax Number	:

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

Provider Enumeration Date	:	06/29/2023
Last Update Date	:	06/30/2023

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Directions to “ KORTNEY BALL L.P.C., S.C.L.” Practice Location

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