Individual
MRS. GRACE BALLARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSW, LADC, LCSW
Contact information
Practice address
1232 S ATLANTA PL, TULSA, OK 74104-4311
(918) 508-9696
Mailing address
1232 S ATLANTA PL, TULSA, OK 74104-4311
(918) 508-9696
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
967
OK
101YM0800X
Mental Health Counselor
4548
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200398400A
—
OK
Enumeration date
01/20/2010
Last updated
10/16/2013
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