Individual
DR. LUTISSUA D BALLARD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PSYD
Contact information
Practice address
210 W CONTINENTAL RD STE 229, GREEN VALLEY, AZ 85622-3596
(520) 329-1579
Mailing address
PO BOX 204, FORT MILL, SC 29716-0204
(520) 329-1579
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
4480
AZ
103TC2200X
Clinical Child & Adolescent Psychologist
4480
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
914097
—
AZ
05
—
Z194557
—
AZ
Enumeration date
04/22/2014
Last updated
08/04/2025
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