Provider Demographics
NPI:1255455218
Name:BALLARD, VI (MFT)
Entity type:Individual
Prefix:MS
First Name:VI
Middle Name:
Last Name:BALLARD
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:MS
Other - First Name:VIOLA
Other - Middle Name:
Other - Last Name:BALLARD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3424 W CARSON ST STE 580
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90503-5722
Mailing Address - Country:US
Mailing Address - Phone:310-373-7994
Mailing Address - Fax:310-373-7995
Practice Address - Street 1:3424 W CARSON ST STE 580
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503-5722
Practice Address - Country:US
Practice Address - Phone:310-373-7994
Practice Address - Fax:310-373-7995
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC35376106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist