Provider Demographics
NPI:1063070639
Name:BALLARD, NATASHA LEE
Entity type:Individual
Prefix:
First Name:NATASHA
Middle Name:LEE
Last Name:BALLARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8310 PARC PL STE A
Mailing Address - Street 2:
Mailing Address - City:CHALMETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70043-1646
Mailing Address - Country:US
Mailing Address - Phone:504-285-8009
Mailing Address - Fax:504-395-0267
Practice Address - Street 1:8301 PARC PLACE
Practice Address - Street 2:SUITE A
Practice Address - City:CHALMETTE
Practice Address - State:LA
Practice Address - Zip Code:70043
Practice Address - Country:US
Practice Address - Phone:504-285-8009
Practice Address - Fax:504-395-0267
Is Sole Proprietor?:No
Enumeration Date:2019-05-30
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YS0200X, 171M00000X
LA7259101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA465057182Medicaid