Provider Demographics
NPI:1841287885
Name:BALLAINE PSYCHOLOGICAL SERVICES INC
Entity type:Organization
Organization Name:BALLAINE PSYCHOLOGICAL SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:KORNELIA
Authorized Official - Middle Name:
Authorized Official - Last Name:GRABINSKA
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:907-479-8933
Mailing Address - Street 1:1040 MEADOW MOUSE RD
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99709-6618
Mailing Address - Country:US
Mailing Address - Phone:907-479-8933
Mailing Address - Fax:
Practice Address - Street 1:1040 MEADOW MOUSE RD
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99709-6618
Practice Address - Country:US
Practice Address - Phone:907-479-8933
Practice Address - Fax:907-479-8934
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-04
Last Update Date:2020-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKK153178Medicare PIN