Provider Demographics
NPI:1962763334
Name:BALL, LUCILLE JEAN (LMFT WITH A PHD)
Entity type:Individual
Prefix:DR
First Name:LUCILLE
Middle Name:JEAN
Last Name:BALL
Suffix:
Gender:F
Credentials:LMFT WITH A PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1801 HIGHWAY 99 N # 3
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97520-9152
Mailing Address - Country:US
Mailing Address - Phone:541-840-1117
Mailing Address - Fax:
Practice Address - Street 1:1801 HIGHWAY 99 N # 3
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:OR
Practice Address - Zip Code:97520-9152
Practice Address - Country:US
Practice Address - Phone:541-840-1117
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-01
Last Update Date:2012-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORT0431106H00000X
CAMFT29381106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORNONEOtherNONE
ORNONEOtherNONE