Provider Demographics
NPI:1407440175
Name:BALLARD, DAVID (MA, LAC, NCC)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:BALLARD
Suffix:
Gender:M
Credentials:MA, LAC, NCC
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 21275
Mailing Address - Street 2:
Mailing Address - City:WICKENBURG
Mailing Address - State:AZ
Mailing Address - Zip Code:85358-6275
Mailing Address - Country:US
Mailing Address - Phone:480-694-5707
Mailing Address - Fax:
Practice Address - Street 1:18789 N REEMS RD STE 260
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85374-8648
Practice Address - Country:US
Practice Address - Phone:480-694-5707
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-23
Last Update Date:2021-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor