Provider Demographics
NPI:1629040928
Name:BALLARD-FRAZINE, CHRISTIE SUE (MA LMFT LLP)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTIE
Middle Name:SUE
Last Name:BALLARD-FRAZINE
Suffix:
Gender:F
Credentials:MA LMFT LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 PLEASANT ST
Mailing Address - Street 2:
Mailing Address - City:STURGIS
Mailing Address - State:MI
Mailing Address - Zip Code:49091-1760
Mailing Address - Country:US
Mailing Address - Phone:126-922-1248
Mailing Address - Fax:
Practice Address - Street 1:107 PLEASANT ST
Practice Address - Street 2:
Practice Address - City:STURGIS
Practice Address - State:MI
Practice Address - Zip Code:49091-1760
Practice Address - Country:US
Practice Address - Phone:269-221-2488
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2022-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4101006166106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP108958190OtherBCBS
MI1708146Medicaid
MIP108958190OtherBCBS