Provider Demographics
NPI:1932813045
Name:BALL, MAVIS (LPC)
Entity Type:Individual
Prefix:
First Name:MAVIS
Middle Name:
Last Name:BALL
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2716 MURPHY DR
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76021-4936
Mailing Address - Country:US
Mailing Address - Phone:817-583-2894
Mailing Address - Fax:817-583-2894
Practice Address - Street 1:2716 MURPHY DR
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:TX
Practice Address - Zip Code:76021-4936
Practice Address - Country:US
Practice Address - Phone:817-583-2894
Practice Address - Fax:817-583-2894
Is Sole Proprietor?:No
Enumeration Date:2023-01-12
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX68474101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health