Individual
LYNETTE BALLARD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
5368297-3501
UT
Other
Enumeration date
08/31/2016
Last updated
08/31/2016
Update your record
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