Provider Demographics
NPI:1205895042
Name:BALLIETTE, BARBARA SUE
Entity type:Individual
Prefix:
First Name:BARBARA
Middle Name:SUE
Last Name:BALLIETTE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:BARBARA
Other - Middle Name:
Other - Last Name:BALLIETTE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC
Mailing Address - Street 1:2319 FOOTHILL DR
Mailing Address - Street 2:SUITE 275C
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84109-1489
Mailing Address - Country:US
Mailing Address - Phone:801-467-1496
Mailing Address - Fax:801-467-1496
Practice Address - Street 1:2319 FOOTHILL DR
Practice Address - Street 2:SUITE 275C
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84109-1489
Practice Address - Country:US
Practice Address - Phone:801-467-1496
Practice Address - Fax:801-467-1496
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-21
Last Update Date:2010-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5075697-6004101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health