Provider Demographics
NPI:1255942884
Name:BALLAS, THOMAS (PHD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:
Last Name:BALLAS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8158 WASHINGTON BLVD APT 436
Mailing Address - Street 2:
Mailing Address - City:JESSUP
Mailing Address - State:MD
Mailing Address - Zip Code:20794-8801
Mailing Address - Country:US
Mailing Address - Phone:330-327-0727
Mailing Address - Fax:
Practice Address - Street 1:8158 WASHINGTON BLVD APT 436
Practice Address - Street 2:
Practice Address - City:JESSUP
Practice Address - State:MD
Practice Address - Zip Code:20794-8801
Practice Address - Country:US
Practice Address - Phone:330-327-0727
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-17
Last Update Date:2024-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810007755103TC0700X
NY205944103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical