Provider Demographics
NPI:1255952362
Name:BALLARD, TAYLOR S (LMFT)
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:S
Last Name:BALLARD
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8008 SLIDE RD STE 24
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79424-2828
Mailing Address - Country:US
Mailing Address - Phone:806-223-4494
Mailing Address - Fax:
Practice Address - Street 1:8008 SLIDE RD STE 24
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79424-2828
Practice Address - Country:US
Practice Address - Phone:806-223-4494
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-29
Last Update Date:2024-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX203189106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty