Individual
MS. MAYNON MICHELLE BALLOW
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CLINICAL NUTRITION/B
Contact information
Practice address
4209 MCKINNEY AVENUE SUITE 202-C, DALLAS, TX 75207
(214) 641-8885
Mailing address
4707 PURDUE AVENUE, DALLAS, TX 75209
Taxonomy
Speciality
Code
Description
License number
State
103TH0004X
Health Psychologist
Primary
—
TX
133VN1006X
Metabolic Nutrition Registered Dietitian
—
TX
Other
Enumeration date
11/14/2013
Last updated
11/14/2013
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