Provider Demographics
NPI:1689264350
Name:BALLARD, CARLOS
Entity Type:Individual
Prefix:MR
First Name:CARLOS
Middle Name:
Last Name:BALLARD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1448 BROOKPARK
Mailing Address - Street 2:APT 1
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43612
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1448 BROOKPARK
Practice Address - Street 2:APT 1
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43612
Practice Address - Country:US
Practice Address - Phone:419-890-2011
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-26
Last Update Date:2021-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)