Individual
DR. ILDIKO BALLA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
4200 S HULEN ST STE 658, FORT WORTH, TX 76109-4987
(682) 597-3933
(817) 274-8443
Mailing address
2136 CLIFF PARK, FORT WORTH, TX 76134-1016
(682) 597-3933
(817) 274-8443
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
16553
TX
103TC0700X
Clinical Psychologist
Primary
32879
TX
103TC1900X
Counseling Psychologist
32879
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
028537102
—
TX
Enumeration date
05/22/2007
Last updated
03/07/2012
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