Provider Demographics
NPI:1962618850
Name:BALLARD, TAMARA J (LPC)
Entity type:Individual
Prefix:
First Name:TAMARA
Middle Name:J
Last Name:BALLARD
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7150 CAMPUS DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920-3177
Mailing Address - Country:US
Mailing Address - Phone:800-804-5008
Mailing Address - Fax:719-538-1439
Practice Address - Street 1:7150 CAMPUS DR
Practice Address - Street 2:SUITE 300
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-3177
Practice Address - Country:US
Practice Address - Phone:800-804-5008
Practice Address - Fax:719-538-1439
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3860101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional