Provider Demographics
NPI:1225042625
Name:BALL, THOMAS STRAND (PH D)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:STRAND
Last Name:BALL
Suffix:
Gender:M
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1637 BUTTERNUT WAY
Mailing Address - Street 2:
Mailing Address - City:DIAMOND BAR
Mailing Address - State:CA
Mailing Address - Zip Code:91765-2506
Mailing Address - Country:US
Mailing Address - Phone:909-860-1237
Mailing Address - Fax:909-860-8467
Practice Address - Street 1:1200 SOUTH DIAMOND BAR BLVD
Practice Address - Street 2:SUITE 207
Practice Address - City:DIAMOND BAR
Practice Address - State:CA
Practice Address - Zip Code:91765-2506
Practice Address - Country:US
Practice Address - Phone:909-860-1237
Practice Address - Fax:909-860-8467
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY2465103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CP2465Medicare ID - Type Unspecified
CP2465Medicare UPIN