Provider Demographics
NPI:1386367464
Name:BALLANTYNE, TONIA (PSYD)
Entity type:Individual
Prefix:DR
First Name:TONIA
Middle Name:
Last Name:BALLANTYNE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3647 FREDERICK DR
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48105-2851
Mailing Address - Country:US
Mailing Address - Phone:231-566-4477
Mailing Address - Fax:
Practice Address - Street 1:3647 FREDERICK DR
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48105-2851
Practice Address - Country:US
Practice Address - Phone:231-563-3959
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-22
Last Update Date:2022-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist