Provider Demographics
NPI:1891026936
Name:BALLARD, RONNETTE P (PSYD)
Entity type:Individual
Prefix:DR
First Name:RONNETTE
Middle Name:P
Last Name:BALLARD
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 1:103 12TH ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:PFLUGERVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78660-3960
Mailing Address - Country:US
Mailing Address - Phone:512-704-8349
Mailing Address - Fax:
Practice Address - Street 1:103 12TH ST
Practice Address - Street 2:SUITE 201
Practice Address - City:PFLUGERVILLE
Practice Address - State:TX
Practice Address - Zip Code:78660-3960
Practice Address - Country:US
Practice Address - Phone:512-704-8349
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-28
Last Update Date:2014-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX34216103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2107872Medicaid
TX614371Medicare PIN