Provider Demographics
NPI:1336688654
Name:BALL, CARILEE (LPC)
Entity Type:Individual
Prefix:MRS
First Name:CARILEE
Middle Name:
Last Name:BALL
Suffix:
Gender:F
Credentials:LPC
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 473
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:MO
Mailing Address - Zip Code:65560-0473
Mailing Address - Country:US
Mailing Address - Phone:573-247-2300
Mailing Address - Fax:
Practice Address - Street 1:838 COUNTY ROAD 3233
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:MO
Practice Address - Zip Code:65560-0473
Practice Address - Country:US
Practice Address - Phone:573-247-2300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-20
Last Update Date:2017-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013042053101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional