Provider Demographics
NPI:1780776153
Name:BALLIETT-BOX, LAURA CHRISTINE (LPC)
Entity type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:CHRISTINE
Last Name:BALLIETT-BOX
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MS
Other - First Name:LAURA
Other - Middle Name:CHRISTINE
Other - Last Name:BALLIETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:100 NW 63RD ST STE 100
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73116-8208
Mailing Address - Country:US
Mailing Address - Phone:405-607-1717
Mailing Address - Fax:405-635-8417
Practice Address - Street 1:744 SE 25TH STREET
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73129
Practice Address - Country:US
Practice Address - Phone:405-636-1463
Practice Address - Fax:405-635-8417
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2019-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1397101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1397OtherLPC