Provider Demographics
NPI:1144581950
Name:BALLARD, ANTHONY WADE (RAS)
Entity type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:WADE
Last Name:BALLARD
Suffix:
Gender:M
Credentials:RAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1015 NORTH ST
Mailing Address - Street 2:
Mailing Address - City:YREKA
Mailing Address - State:CA
Mailing Address - Zip Code:96097-2233
Mailing Address - Country:US
Mailing Address - Phone:309-917-6774
Mailing Address - Fax:
Practice Address - Street 1:1015 NORTH ST
Practice Address - Street 2:
Practice Address - City:YREKA
Practice Address - State:CA
Practice Address - Zip Code:96097-2233
Practice Address - Country:US
Practice Address - Phone:309-176-7745
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-07
Last Update Date:2025-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAB1205182016101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)