Provider Demographics
NPI:1124284807
Name:BALLIET, LAURA ANN (LPC)
Entity type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:ANN
Last Name:BALLIET
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:622 DOMINIC DR
Mailing Address - Street 2:
Mailing Address - City:CUYAHOGA FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44223-3800
Mailing Address - Country:US
Mailing Address - Phone:330-928-8519
Mailing Address - Fax:
Practice Address - Street 1:230 S COURT ST
Practice Address - Street 2:SUITE 5
Practice Address - City:MEDINA
Practice Address - State:OH
Practice Address - Zip Code:44256-2275
Practice Address - Country:US
Practice Address - Phone:330-723-7977
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-01
Last Update Date:2008-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCO501211101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor