Basic Information
| Provider Information | |||||||||
| NPI: | 1730424573 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BALL | ||||||||
| FirstName: | VINCENT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 114 W DELAWARE AVE | ||||||||
| Address2: | |||||||||
| City: | NOWATA | ||||||||
| State: | OK | ||||||||
| PostalCode: | 740482601 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9182731841 | ||||||||
| FaxNumber: | 9182731843 | ||||||||
| Practice Location | |||||||||
| Address1: | 138 S MAIN | ||||||||
| Address2: | |||||||||
| City: | AFTON | ||||||||
| State: | OK | ||||||||
| PostalCode: | 743311822 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9182574244 | ||||||||
| FaxNumber: | 9182574247 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/05/2012 | ||||||||
| LastUpdateDate: | 12/05/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.