Provider Demographics
NPI:1063455863
Name:BALLARD, KAY R (LPC, LMFT)
Entity Type:Individual
Prefix:
First Name:KAY
Middle Name:R
Last Name:BALLARD
Suffix:
Gender:F
Credentials:LPC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 12883
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73157-2883
Mailing Address - Country:US
Mailing Address - Phone:405-858-0600
Mailing Address - Fax:405-858-0602
Practice Address - Street 1:2212 NW 50TH ST
Practice Address - Street 2:SUITE 172
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-8086
Practice Address - Country:US
Practice Address - Phone:405-640-8121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-13
Last Update Date:2009-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK569101YP2500X
OK1010106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist