Provider Demographics
NPI:1497837314
Name:BALLARD, THOMAS BYRON JR (PHD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:BYRON
Last Name:BALLARD
Suffix:JR
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26891 SPRING ST
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN CAPISTRANO
Mailing Address - State:CA
Mailing Address - Zip Code:92675-2692
Mailing Address - Country:US
Mailing Address - Phone:949-361-7891
Mailing Address - Fax:949-361-7895
Practice Address - Street 1:26891 SPRING ST
Practice Address - Street 2:
Practice Address - City:SAN JUAN CAPISTRANO
Practice Address - State:CA
Practice Address - Zip Code:92675-2692
Practice Address - Country:US
Practice Address - Phone:949-361-7891
Practice Address - Fax:949-361-7895
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY11676103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical