Provider Demographics
NPI:1679356398
Name:BALLI, ALLYSON R (TLMHC)
Entity type:Individual
Prefix:
First Name:ALLYSON
Middle Name:R
Last Name:BALLI
Suffix:
Gender:F
Credentials:TLMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 233
Mailing Address - Street 2:
Mailing Address - City:GRUNDY CENTER
Mailing Address - State:IA
Mailing Address - Zip Code:50638-0233
Mailing Address - Country:US
Mailing Address - Phone:800-531-4236
Mailing Address - Fax:
Practice Address - Street 1:2208 E 52ND ST
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52807-2726
Practice Address - Country:US
Practice Address - Phone:800-531-4236
Practice Address - Fax:319-483-6661
Is Sole Proprietor?:No
Enumeration Date:2023-08-16
Last Update Date:2024-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA120990101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health