Provider Demographics
NPI:1942688411
Name:BALL, PAMELA (LCDC)
Entity Type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:
Last Name:BALL
Suffix:
Gender:F
Credentials:LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57 LAKE FOREST CIR
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77384-3129
Mailing Address - Country:US
Mailing Address - Phone:214-709-1586
Mailing Address - Fax:
Practice Address - Street 1:26009 BUDDE RD STE B200
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77380-2064
Practice Address - Country:US
Practice Address - Phone:936-900-8566
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-15
Last Update Date:2015-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12384101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)