Provider Demographics
NPI:1003596933
Name:BALLIETT VELEY, DEBORAH SUE (LISW, LNHA)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:SUE
Last Name:BALLIETT VELEY
Suffix:
Gender:F
Credentials:LISW, LNHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1365 BEECHDALE DR
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44907-2801
Mailing Address - Country:US
Mailing Address - Phone:937-532-5084
Mailing Address - Fax:
Practice Address - Street 1:1365 BEECHDALE DR
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:OH
Practice Address - Zip Code:44907-2801
Practice Address - Country:US
Practice Address - Phone:937-532-5084
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-25
Last Update Date:2023-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI80011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical