Provider Demographics
NPI:1720765985
Name:BALL, KORTNEY (LPC, SCL)
Entity Type:Individual
Prefix:
First Name:KORTNEY
Middle Name:
Last Name:BALL
Suffix:
Gender:F
Credentials:LPC, SCL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5124 BIRCH AVE
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:MI
Mailing Address - Zip Code:48450-9261
Mailing Address - Country:US
Mailing Address - Phone:810-300-9465
Mailing Address - Fax:
Practice Address - Street 1:7285 LAKESHORE RD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:MI
Practice Address - Zip Code:48450-9772
Practice Address - Country:US
Practice Address - Phone:810-300-9465
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-29
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health