Provider Demographics
NPI:1447549555
Name:BALLARD, CELESTE MARIE (MA, LCPC)
Entity type:Individual
Prefix:MS
First Name:CELESTE
Middle Name:MARIE
Last Name:BALLARD
Suffix:
Gender:F
Credentials:MA, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:217 E CALHOUN
Mailing Address - Street 2:H
Mailing Address - City:WOODSTOCK
Mailing Address - State:IL
Mailing Address - Zip Code:60098
Mailing Address - Country:US
Mailing Address - Phone:773-226-5603
Mailing Address - Fax:888-796-6903
Practice Address - Street 1:217 E CALHOUN
Practice Address - Street 2:H
Practice Address - City:WOODSTOCK
Practice Address - State:IL
Practice Address - Zip Code:60098
Practice Address - Country:US
Practice Address - Phone:773-226-5603
Practice Address - Fax:888-796-6903
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-30
Last Update Date:2014-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180007509101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional