Provider Demographics
NPI:1508177320
Name:BALLARD, SHELLEY SUE (MA)
Entity Type:Individual
Prefix:
First Name:SHELLEY
Middle Name:SUE
Last Name:BALLARD
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 BRUSHY CREEK TRL
Mailing Address - Street 2:
Mailing Address - City:HUTTO
Mailing Address - State:TX
Mailing Address - Zip Code:78634-5413
Mailing Address - Country:US
Mailing Address - Phone:512-468-1495
Mailing Address - Fax:
Practice Address - Street 1:118 BRUSHY CREEK TRL
Practice Address - Street 2:
Practice Address - City:HUTTO
Practice Address - State:TX
Practice Address - Zip Code:78634-5413
Practice Address - Country:US
Practice Address - Phone:512-468-1495
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-25
Last Update Date:2010-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX61191101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional