Ballestas, Mirna E

Ballestas, Mirna E is an individual health care provider with primary practice located at 4633 N Western Ave Ste 205 , Chicago IL 60625-2087. She recently has 2 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Mental Health, Behavioral Health & Social Service Providers / Clinical. Behavioral Health & Social Service Providers / Clinical is her primary health care specialty. Ballestas, Mirna E can be contacted via phone (312) 476-9588.

Contact Information

Primary practice address
4633 N Western Ave Ste 205 Chicago IL 60625-2087
Phone: (312) 476-9588
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Mental Health 101YM0800X 180-005584 Illinois
Behavioral Health & Social Service Providers / Clinical 103TC0700X 071.007650 Illinois

Profile Details

NPI number 1942427521
LBN Legal business name Ballestas, Mirna E
Credentials PSY.D.
Entity Individual
Sole proprietor 1 No
Enumeration date Apr 18th, 2007
Last updated Aug 25th, 2020 - about 4 years ago

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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