MEDICARE: TAMARA J 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	3860	CO

General Provider Information

NPI Number	:	1962618850
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAMARA J BALLARD LPC

Provider Business Mailing Address
First Line	:	7150 CAMPUS DR
Second Line	:	SUITE 300
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80920-3177
Country	:	US
Telephone Number	:	800-804-5008
Fax Number	:	719-538-1439

Provider Business Practice Location Address
First Line	:	7150 CAMPUS DR
Second Line	:	SUITE 300
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80920-3177
Country	:	US
Telephone Number	:	800-804-5008
Fax Number	:	719-538-1439

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

Provider Enumeration Date	:	05/15/2007
Last Update Date	:	07/08/2007

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