Provider Demographics
NPI:1679847123
Name:BALL, DEANNA LYNN (LPC, LCDC)
Entity Type:Individual
Prefix:
First Name:DEANNA
Middle Name:LYNN
Last Name:BALL
Suffix:
Gender:F
Credentials:LPC, LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1109 25TH ST
Mailing Address - Street 2:
Mailing Address - City:GALVESTON
Mailing Address - State:TX
Mailing Address - Zip Code:77550-4408
Mailing Address - Country:US
Mailing Address - Phone:409-392-5502
Mailing Address - Fax:409-331-2046
Practice Address - Street 1:6511 STEWART RD # 7-3
Practice Address - Street 2:
Practice Address - City:GALVESTON
Practice Address - State:TX
Practice Address - Zip Code:77551-2800
Practice Address - Country:US
Practice Address - Phone:409-392-5502
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-01
Last Update Date:2021-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX70672101Y00000X, 101YM0800X, 101YA0400X, 101YP2500X
LA8518101Y00000X, 101YA0400X, 101YM0800X, 101YP2500X
10114101YA0400X
TX10114101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional