Provider Demographics
NPI:1588786396
Name:FRAZIER, JOAN BALLANCE
Entity type:Individual
Prefix:
First Name:JOAN
Middle Name:BALLANCE
Last Name:FRAZIER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JOAN
Other - Middle Name:BALLANCE
Other - Last Name:FRAZIER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMFT, LMHC
Mailing Address - Street 1:2607 TACITO TRL
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32223-7106
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3715 SAN JOSE PL STE 1
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32257-8867
Practice Address - Country:US
Practice Address - Phone:904-880-0800
Practice Address - Fax:904-880-0802
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 2773101YM0800X
FLMT 1441106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist