Provider Demographics
NPI:1770990624
Name:BALL AND BROSCH COUNSELING SERVICES: MARRIAGE, FAMILY, & CHILD
Entity type:Organization
Organization Name:BALL AND BROSCH COUNSELING SERVICES: MARRIAGE, FAMILY, & CHILD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESENT AND LMFT
Authorized Official - Prefix:MR
Authorized Official - First Name:CORDELL
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:BALL
Authorized Official - Suffix:
Authorized Official - Credentials:MFT
Authorized Official - Phone:949-887-3414
Mailing Address - Street 1:2030 E 4TH ST
Mailing Address - Street 2:SUITE 131C
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-3940
Mailing Address - Country:US
Mailing Address - Phone:949-887-3414
Mailing Address - Fax:
Practice Address - Street 1:2030 E 4TH ST
Practice Address - Street 2:SUITE 131C
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-3940
Practice Address - Country:US
Practice Address - Phone:949-887-3414
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-11
Last Update Date:2014-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA45955106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty