Provider Demographics
NPI:1700068525
Name:BALLENGER, CATHY LOUISE (LMFT)
Entity Type:Individual
Prefix:MISS
First Name:CATHY
Middle Name:LOUISE
Last Name:BALLENGER
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:P.O. BOX 283
Mailing Address - Street 2:
Mailing Address - City:ATWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:92811
Mailing Address - Country:US
Mailing Address - Phone:714-478-5170
Mailing Address - Fax:866-536-9384
Practice Address - Street 1:2113 E. CHAPMAN AVE.
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92831
Practice Address - Country:US
Practice Address - Phone:714-478-5170
Practice Address - Fax:866-536-9384
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-04
Last Update Date:2007-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 39091106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist