Provider Demographics
NPI:1770973109
Name:BALLAS, MARI LAURINE (LPCC)
Entity type:Individual
Prefix:
First Name:MARI
Middle Name:LAURINE
Last Name:BALLAS
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 1:2600 TUSCARAWAS ST W STE 340
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44708-4644
Mailing Address - Country:US
Mailing Address - Phone:330-493-9607
Mailing Address - Fax:330-493-9609
Practice Address - Street 1:2600 TUSCARAWAS ST W STE 340
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44708
Practice Address - Country:US
Practice Address - Phone:330-493-9607
Practice Address - Fax:330-493-9609
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-23
Last Update Date:2018-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.1300394101Y00000X
OHE.1700063101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor