Basic Information
| Provider Information | |||||||||
| NPI: | 1457726341 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | BERNARD BALL AND ASSOC INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 66104 | ||||||||
| Address2: | |||||||||
| City: | ROSEVILLE | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480666104 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3135700974 | ||||||||
| FaxNumber: | 5863628803 | ||||||||
| Practice Location | |||||||||
| Address1: | 12200 E 13 MILE RD STE 150 | ||||||||
| Address2: | |||||||||
| City: | WARREN | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480933096 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5867510999 | ||||||||
| FaxNumber: | 5867511703 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/03/2015 | ||||||||
| LastUpdateDate: | 12/15/2017 | ||||||||
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| AuthorizedOfficialLastName: | BALL | ||||||||
| AuthorizedOfficialFirstName: | BERNARD | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 3135700974 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | LMSW | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 6801061377 | MI | Y | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.