Provider Demographics
NPI:1538367669
Name:EELSSEN INTERNATIONAL, LLC
Entity type:Organization
Organization Name:EELSSEN INTERNATIONAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:M
Authorized Official - Last Name:BALLARD, III
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:410-361-0658
Mailing Address - Street 1:PO BOX 281
Mailing Address - Street 2:
Mailing Address - City:ODENTON
Mailing Address - State:MD
Mailing Address - Zip Code:21113-0281
Mailing Address - Country:US
Mailing Address - Phone:410-361-0658
Mailing Address - Fax:410-647-7931
Practice Address - Street 1:4200 FORBES BLVD STE 202
Practice Address - Street 2:
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-4829
Practice Address - Country:US
Practice Address - Phone:410-361-0658
Practice Address - Fax:410-647-7931
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-10
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
7308914OtherAETNA