Individual
ANGELA SUSAN BALLARD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMFT 120205, PCCI
Contact information
Practice address
1033 LAUREL ST, SAN CARLOS, CA 94070-3918
(650) 785-2562
Mailing address
119 CHESTER ST, MENLO PARK, CA 94025-2517
(650) 862-2270
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
103TC0700X
Clinical Psychologist
Primary
LMFT120205
CA
Other
Enumeration date
08/02/2017
Last updated
07/28/2020
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