Provider Demographics
NPI:1972269199
Name:BALLENTINE, PAOLA (BCBA)
Entity Type:Individual
Prefix:
First Name:PAOLA
Middle Name:
Last Name:BALLENTINE
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11009 AFFINITY LN APT 7307
Mailing Address - Street 2:
Mailing Address - City:ROWLETT
Mailing Address - State:TX
Mailing Address - Zip Code:75089-0149
Mailing Address - Country:US
Mailing Address - Phone:972-835-6200
Mailing Address - Fax:
Practice Address - Street 1:611 S HIGHWAY 78 STE 123
Practice Address - Street 2:
Practice Address - City:WYLIE
Practice Address - State:TX
Practice Address - Zip Code:75098-4112
Practice Address - Country:US
Practice Address - Phone:972-469-5700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-11
Last Update Date:2021-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst