Provider Demographics
NPI:1619944246
Name:BALL, DAVID LOREN (M DIV MS MFT)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:LOREN
Last Name:BALL
Suffix:
Gender:M
Credentials:M DIV MS MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1135 PINE ST STE 203
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96001-0750
Mailing Address - Country:US
Mailing Address - Phone:530-806-3119
Mailing Address - Fax:
Practice Address - Street 1:1135 PINE ST STE 203
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001
Practice Address - Country:US
Practice Address - Phone:530-806-3119
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-02
Last Update Date:2019-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT34591106H00000X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1619944246OtherNPI