Provider Demographics
NPI:1295111904
Name:BALLARD, MARIA LYNN
Entity type:Individual
Prefix:MS
First Name:MARIA
Middle Name:LYNN
Last Name:BALLARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:741 SESAME ST STE 1B
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99503-6657
Mailing Address - Country:US
Mailing Address - Phone:907-444-4867
Mailing Address - Fax:844-628-1611
Practice Address - Street 1:741 SESAME ST STE 1B
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-6657
Practice Address - Country:US
Practice Address - Phone:907-444-4867
Practice Address - Fax:844-628-1611
Is Sole Proprietor?:No
Enumeration Date:2015-08-04
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
AK130219101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health