Provider Demographics
NPI:1316703440
Name:BALL, GEOFFREY L (LCDC)
Entity type:Individual
Prefix:
First Name:GEOFFREY
Middle Name:L
Last Name:BALL
Suffix:
Gender:M
Credentials:LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2030 FOXTAIL CREEK CT
Mailing Address - Street 2:
Mailing Address - City:CROSBY
Mailing Address - State:TX
Mailing Address - Zip Code:77532-1983
Mailing Address - Country:US
Mailing Address - Phone:832-618-0608
Mailing Address - Fax:
Practice Address - Street 1:2627 CAROLINE ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77004-1114
Practice Address - Country:US
Practice Address - Phone:832-392-7593
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-26
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14588101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)