Provider Demographics
NPI:1972145878
Name:BALLARD, ELLAINE M (MS, LMHC, NCC)
Entity type:Individual
Prefix:
First Name:ELLAINE
Middle Name:M
Last Name:BALLARD
Suffix:
Gender:F
Credentials:MS, LMHC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 WOODLAND AVE
Mailing Address - Street 2:
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50265-2306
Mailing Address - Country:US
Mailing Address - Phone:515-309-2832
Mailing Address - Fax:
Practice Address - Street 1:1300 WOODLAND AVE
Practice Address - Street 2:
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50265-2306
Practice Address - Country:US
Practice Address - Phone:515-309-2832
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-11
Last Update Date:2024-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA096571101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health