Provider Demographics
NPI:1285872127
Name:BALLMAN, JILL K (MA, LPC, CFT, CACD)
Entity type:Individual
Prefix:MS
First Name:JILL
Middle Name:K
Last Name:BALLMAN
Suffix:
Gender:F
Credentials:MA, LPC, CFT, CACD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:327 N. WASHINGTON AVE.
Mailing Address - Street 2:SUITE 105
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18503
Mailing Address - Country:US
Mailing Address - Phone:570-909-9324
Mailing Address - Fax:
Practice Address - Street 1:327 N WASHINGTON AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18503-1549
Practice Address - Country:US
Practice Address - Phone:570-909-9324
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-30
Last Update Date:2009-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)