Provider Demographics
NPI:1790674653
Name:BALLENGER, KHORTNEY NAKOHL (RBT)
Entity type:Individual
Prefix:
First Name:KHORTNEY
Middle Name:NAKOHL
Last Name:BALLENGER
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6615 SHELLY ST
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:OH
Mailing Address - Zip Code:45005-2642
Mailing Address - Country:US
Mailing Address - Phone:937-931-2925
Mailing Address - Fax:
Practice Address - Street 1:6615 SHELLY ST
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:OH
Practice Address - Zip Code:45005-2642
Practice Address - Country:US
Practice Address - Phone:937-931-2925
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-02
Last Update Date:2025-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRBT25446112106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician