Provider Demographics
NPI:1033890470
Name:PEWEE, BALLAH G (QMHP)
Entity Type:Individual
Prefix:
First Name:BALLAH
Middle Name:G
Last Name:PEWEE
Suffix:
Gender:M
Credentials:QMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1185 AMERICANA BLVD APT 1207
Mailing Address - Street 2:
Mailing Address - City:ZACHARY
Mailing Address - State:LA
Mailing Address - Zip Code:70791-7856
Mailing Address - Country:US
Mailing Address - Phone:432-599-7506
Mailing Address - Fax:
Practice Address - Street 1:14235 WINNERS CIR APT H114
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79763-2001
Practice Address - Country:US
Practice Address - Phone:432-599-7506
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-28
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health