MEDICARE: LISA R. BALLINGER M.A., LCPC

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	180003520	IL
2	101YP2500X	Professional Counselor	180003520	IL

General Provider Information

NPI Number	:	1811985468
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA R. BALLINGER M.A., LCPC

Provider Business Mailing Address
First Line	:	611 W PARK ST
Second Line	:	FAPC
City	:	URBANA
State	:	IL
Zip	:	61801-2500
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2512 HURST DR STE 120
Second Line	:
City	:	MATTOON
State	:	IL
Zip	:	61938-9200
Country	:	US
Telephone Number	:	217-258-7590
Fax Number	:

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

Provider Enumeration Date	:	10/07/2005
Last Update Date	:	01/28/2025

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