Provider Demographics
NPI:1255225496
Name:BALLARD, COURTNEY NICHOLE
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:NICHOLE
Last Name:BALLARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1018 GLENRIDGE DR APT D
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40242-7704
Mailing Address - Country:US
Mailing Address - Phone:502-373-9656
Mailing Address - Fax:
Practice Address - Street 1:7509 CHARLESTOWN PIKE
Practice Address - Street 2:
Practice Address - City:CHARLESTOWN
Practice Address - State:IN
Practice Address - Zip Code:47111-9623
Practice Address - Country:US
Practice Address - Phone:812-256-4686
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-04
Last Update Date:2025-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)