Individual
DR. BARBARA BROOKE BALLIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
119 MULBERRY CIR, PONCHATOULA, LA 70454-4962
(985) 386-1060
Mailing address
463 AVALON VILLA DR, PONCHATOULA, LA 70454-9423
(985) 386-8368
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
317
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1086681
WAIVER PROVIDER NUMBER
LA
Enumeration date
10/16/2007
Last updated
05/30/2012
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