Individual
JOHN BALLOU
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
3020 SUNRISE BAY AVE, NORTH LAS VEGAS, NV 89031-0540
(702) 675-0201
Mailing address
3020 SUNRISE BAY AVE, NORTH LAS VEGAS, NV 89031-0540
(702) 675-0201
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
225400000X
Rehabilitation Practitioner
Primary
—
—
Other
Enumeration date
08/21/2012
Last updated
03/26/2013
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