Provider Demographics
NPI:1154068385
Name:BALL, ALLYSON (LISW)
Entity type:Individual
Prefix:
First Name:ALLYSON
Middle Name:
Last Name:BALL
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 E. MARKET ST.
Mailing Address - Street 2:
Mailing Address - City:CELINA
Mailing Address - State:OH
Mailing Address - Zip Code:45822-1736
Mailing Address - Country:US
Mailing Address - Phone:419-584-5123
Mailing Address - Fax:567-890-7214
Practice Address - Street 1:1820 C ST.
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45804-1832
Practice Address - Country:US
Practice Address - Phone:419-584-5123
Practice Address - Fax:567-890-7214
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-18
Last Update Date:2025-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.25068461041C0700X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0487753Medicaid