Provider Demographics
NPI:1326419110
Name:BALLARD, PHOEBE JANELLE (BCBA)
Entity Type:Individual
Prefix:
First Name:PHOEBE
Middle Name:JANELLE
Last Name:BALLARD
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:PHOEBE
Other - Middle Name:JANELLE
Other - Last Name:MORGON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:564 S DORA ST STE E
Mailing Address - Street 2:
Mailing Address - City:UKIAH
Mailing Address - State:CA
Mailing Address - Zip Code:95482-5465
Mailing Address - Country:US
Mailing Address - Phone:707-462-2388
Mailing Address - Fax:
Practice Address - Street 1:564 S DORA ST STE E
Practice Address - Street 2:
Practice Address - City:UKIAH
Practice Address - State:CA
Practice Address - Zip Code:95482-5465
Practice Address - Country:US
Practice Address - Phone:707-462-2388
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-19
Last Update Date:2015-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst