Provider Demographics
NPI:1811500606
Name:AMY BALLARD THERAPY, PLLC
Entity type:Organization
Organization Name:AMY BALLARD THERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PSYCHOTHERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:M
Authorized Official - Last Name:BALLARD
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:501-200-1444
Mailing Address - Street 1:2003 N ARTHUR ST
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72207-3409
Mailing Address - Country:US
Mailing Address - Phone:501-773-6170
Mailing Address - Fax:
Practice Address - Street 1:2003 N ARTHUR ST
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72207-3409
Practice Address - Country:US
Practice Address - Phone:501-200-1444
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-31
Last Update Date:2020-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty