Provider Demographics
NPI:1295105443
Name:BALLARD, LORRI (LPCC)
Entity type:Individual
Prefix:
First Name:LORRI
Middle Name:
Last Name:BALLARD
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 PEACOCK ALY
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87507-8601
Mailing Address - Country:US
Mailing Address - Phone:505-927-9078
Mailing Address - Fax:
Practice Address - Street 1:19 PEACOCK ALY
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87507-8601
Practice Address - Country:US
Practice Address - Phone:505-927-9078
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-30
Last Update Date:2017-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0188661101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health