Provider Demographics
NPI:1689251902
Name:BALLIEN, LEIGHANN (RBT)
Entity Type:Individual
Prefix:
First Name:LEIGHANN
Middle Name:
Last Name:BALLIEN
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5051 N ALABASTER DR
Mailing Address - Street 2:
Mailing Address - City:HERNANDO
Mailing Address - State:FL
Mailing Address - Zip Code:34442-4002
Mailing Address - Country:US
Mailing Address - Phone:352-464-3042
Mailing Address - Fax:
Practice Address - Street 1:1951 NW 7TH AVE STE 600
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33136-1128
Practice Address - Country:US
Practice Address - Phone:786-723-8674
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-24
Last Update Date:2021-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL20-114974106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician