Provider Demographics
NPI:1265168017
Name:BALLINGER, SKYLAR MARIE (LPC)
Entity type:Individual
Prefix:
First Name:SKYLAR
Middle Name:MARIE
Last Name:BALLINGER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 W SUNNYSIDE RD STE 1
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83402-4642
Mailing Address - Country:US
Mailing Address - Phone:208-529-5777
Mailing Address - Fax:
Practice Address - Street 1:550 W SUNNYSIDE RD STE 1
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83402-4642
Practice Address - Country:US
Practice Address - Phone:208-529-5777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-25
Last Update Date:2022-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLPC-9002101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health