Provider Demographics
NPI:1720547409
Name:HOLCOMB-BALLASH, PLLC
Entity Type:Organization
Organization Name:HOLCOMB-BALLASH, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:J
Authorized Official - Last Name:BALLASH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-549-3188
Mailing Address - Street 1:1130 E 346TH ST
Mailing Address - Street 2:
Mailing Address - City:EASTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44095-2946
Mailing Address - Country:US
Mailing Address - Phone:304-549-3188
Mailing Address - Fax:
Practice Address - Street 1:1500 CLAY HWY #101
Practice Address - Street 2:
Practice Address - City:CLAY
Practice Address - State:WV
Practice Address - Zip Code:25043
Practice Address - Country:US
Practice Address - Phone:304-549-3188
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-13
Last Update Date:2020-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
13834876OtherCAQH PROVIDER ID
1538517354OtherINDIVIDUAL PROVIDER/OWNER NPI