Provider Demographics
NPI:1013290394
Name:BALL, ELIZABETH H (LCSW)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:H
Last Name:BALL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4575 YATES RD
Mailing Address - Street 2:
Mailing Address - City:CROSS PLAINS
Mailing Address - State:TN
Mailing Address - Zip Code:37049-4845
Mailing Address - Country:US
Mailing Address - Phone:210-360-0303
Mailing Address - Fax:210-922-0162
Practice Address - Street 1:4575 YATES RD # 101
Practice Address - Street 2:
Practice Address - City:CROSS PLAINS
Practice Address - State:TN
Practice Address - Zip Code:37049-4845
Practice Address - Country:US
Practice Address - Phone:210-360-0303
Practice Address - Fax:210-615-5721
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-23
Last Update Date:2021-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2560051041C0700X
TN62721041C0700X
TX180561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN06272OtherCLINICAL SOCIAL WORK LICENSE
TX285038002Medicaid