Provider Demographics
NPI:1720620644
Name:BALLARD AVENUE PSYCHIATRY PLLC
Entity Type:Organization
Organization Name:BALLARD AVENUE PSYCHIATRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PSYCHIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:LANG-FURR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:206-455-9008
Mailing Address - Street 1:5306 BALLARD AVE NW STE 317
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98107-4366
Mailing Address - Country:US
Mailing Address - Phone:206-455-9008
Mailing Address - Fax:437-537-5124
Practice Address - Street 1:5306 BALLARD AVE NW STE 317
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98107-4366
Practice Address - Country:US
Practice Address - Phone:206-455-9008
Practice Address - Fax:437-537-5124
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-11
Last Update Date:2019-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health