Provider Demographics
NPI:1114646163
Name:SCHROEFFEL BALLARD, KELI MARIE (LPC)
Entity Type:Individual
Prefix:MS
First Name:KELI
Middle Name:MARIE
Last Name:SCHROEFFEL BALLARD
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:KELI
Other - Middle Name:
Other - Last Name:SCHROEFFEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:139 HOLSTEIN DR
Mailing Address - Street 2:
Mailing Address - City:OAKDALE
Mailing Address - State:PA
Mailing Address - Zip Code:15071-9470
Mailing Address - Country:US
Mailing Address - Phone:480-209-9669
Mailing Address - Fax:
Practice Address - Street 1:139 HOLSTEIN DR
Practice Address - Street 2:
Practice Address - City:OAKDALE
Practice Address - State:PA
Practice Address - Zip Code:15071-9470
Practice Address - Country:US
Practice Address - Phone:480-209-9669
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-23
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC008212101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health