Provider Demographics
NPI:1841920188
Name:BALL, CARLY MCNEIL (MA, LMHC)
Entity type:Individual
Prefix:
First Name:CARLY
Middle Name:MCNEIL
Last Name:BALL
Suffix:
Gender:F
Credentials:MA, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:918 E 48TH ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46205-1946
Mailing Address - Country:US
Mailing Address - Phone:970-708-7608
Mailing Address - Fax:
Practice Address - Street 1:13578 E 131ST ST STE 260
Practice Address - Street 2:
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46037-6401
Practice Address - Country:US
Practice Address - Phone:970-708-7608
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-10
Last Update Date:2022-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39004214A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN39004214AOtherINDIANA PROFESSIONAL LICENSING AGENCY