Provider Demographics
NPI:1518553908
Name:BALL, ELISE
Entity type:Individual
Prefix:
First Name:ELISE
Middle Name:
Last Name:BALL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 ENTERPRISE
Mailing Address - Street 2:
Mailing Address - City:ALISO VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92656-2705
Mailing Address - Country:US
Mailing Address - Phone:949-371-3326
Mailing Address - Fax:732-707-8074
Practice Address - Street 1:65 ENTERPRISE
Practice Address - Street 2:
Practice Address - City:ALISO VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92656-2705
Practice Address - Country:US
Practice Address - Phone:949-371-3326
Practice Address - Fax:310-212-6326
Is Sole Proprietor?:No
Enumeration Date:2020-12-18
Last Update Date:2025-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-22-59590103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst