Provider Demographics
NPI:1487807764
Name:BALLARD, BRITTANY BH (MHRT-CSP)
Entity type:Individual
Prefix:
First Name:BRITTANY
Middle Name:BH
Last Name:BALLARD
Suffix:
Gender:F
Credentials:MHRT-CSP
Other - Prefix:
Other - First Name:BRITTANY
Other - Middle Name:B
Other - Last Name:HAINES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:43 HATCH DRIVE
Mailing Address - Street 2:
Mailing Address - City:CARIBOU
Mailing Address - State:ME
Mailing Address - Zip Code:04736-0000
Mailing Address - Country:US
Mailing Address - Phone:207-498-6431
Mailing Address - Fax:207-492-3181
Practice Address - Street 1:43 HATCH DR
Practice Address - Street 2:
Practice Address - City:CARIBOU
Practice Address - State:ME
Practice Address - Zip Code:04736-2161
Practice Address - Country:US
Practice Address - Phone:207-498-6431
Practice Address - Fax:207-492-3181
Is Sole Proprietor?:No
Enumeration Date:2008-10-30
Last Update Date:2017-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME103850000OtherMAINECARE