Provider Demographics
NPI:1467741405
Name:BALLEW, GEORGE ANTHONY (LCSW)
Entity Type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:ANTHONY
Last Name:BALLEW
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5600 HERITAGE SCHOOL DR
Mailing Address - Street 2:
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84604-7701
Mailing Address - Country:US
Mailing Address - Phone:801-226-4660
Mailing Address - Fax:
Practice Address - Street 1:5600 HERITAGE SCHOOL DR
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84604-7701
Practice Address - Country:US
Practice Address - Phone:801-226-4660
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-30
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8650132-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical