Ballard, Lutissua D

Ballard, Lutissua D is an sole proprietor health care provider with primary practice located at 210 W Continental Rd Ste 229 , Green Valley AZ 85622-3596. She recently has only one registered license in Behavioral Health & Social Service Providers / Clinical Child & Adolescent, which is considered as her primary health care specialty. Ballard, Lutissua D can be contacted via phone (520) 329-1579.

Contact Information

Primary practice address
210 W Continental Rd Ste 229 Green Valley AZ 85622-3596
Phone: (520) 329-1579
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Clinical Child & Adolescent 103TC2200X 4480 Arizona

Profile Details

NPI number 1093135659
LBN Legal business name Ballard, Lutissua D
Credentials PSYD
Entity Individual
Sole proprietor 1 Yes
Enumeration date Apr 22nd, 2014
Last updated Mar 4th, 2024 - about last year

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1093135659 NPPES
Arizona MEDICAID 914097
Arizona MEDICAID Z194557

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