Provider Demographics
NPI:1538648787
Name:BALL, KATIE J (LCSW)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:J
Last Name:BALL
Suffix:
Gender:F
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:PO BOX 1365
Mailing Address - Street 2:
Mailing Address - City:BELGRADE
Mailing Address - State:MT
Mailing Address - Zip Code:59714-1365
Mailing Address - Country:US
Mailing Address - Phone:831-325-8888
Mailing Address - Fax:
Practice Address - Street 1:92 N BROADWAY
Practice Address - Street 2:
Practice Address - City:BELGRADE
Practice Address - State:MT
Practice Address - Zip Code:59714-3701
Practice Address - Country:US
Practice Address - Phone:318-325-8888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-08
Last Update Date:2024-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA850681041C0700X
MTBBH-LCSW-LIC-332481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical