Provider Demographics
NPI:1558499269
Name:BALL, JOHN MICHAEL (LCSW)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:MICHAEL
Last Name:BALL
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12124 HIGHWAY 52 W
Mailing Address - Street 2:
Mailing Address - City:WESTMORELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37186-3245
Mailing Address - Country:US
Mailing Address - Phone:615-644-2000
Mailing Address - Fax:615-644-2078
Practice Address - Street 1:12124 HIGHWAY 52 W
Practice Address - Street 2:
Practice Address - City:WESTMORELAND
Practice Address - State:TN
Practice Address - Zip Code:37186-3245
Practice Address - Country:US
Practice Address - Phone:615-644-2000
Practice Address - Fax:615-644-2078
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2014-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLSW 00000044121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3987803Medicaid
TN103I805360Medicare PIN