Provider Demographics
NPI:1437357712
Name:BALLWEG, CAROL LEE (LPC)
Entity Type:Individual
Prefix:MS
First Name:CAROL
Middle Name:LEE
Last Name:BALLWEG
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 1:9225 13TH ST
Mailing Address - Street 2:
Mailing Address - City:BAY CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97107-9732
Mailing Address - Country:US
Mailing Address - Phone:503-377-4252
Mailing Address - Fax:
Practice Address - Street 1:309 ELM AVE
Practice Address - Street 2:
Practice Address - City:TILLAMOOK
Practice Address - State:OR
Practice Address - Zip Code:97141-3437
Practice Address - Country:US
Practice Address - Phone:503-801-1945
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC1144101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health