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1417470154
PHILLIP BALLASCH
MODESTO, CA
NPI
1417470154
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
101YA0400X Counselor, Addiction (Substance Use Disorder)
(Licence: CA B1211161326)
Enumeration Date
2017-07-25
Last Update Date
2017-07-25
Business Address
PHILLIP BALLASCH
251 E HACKETT RD
MODESTO, CA 95358-9800
Phone number: 209-558-1815
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Mailing Address
PHILLIP BALLASCH
3132 HONEY BEE CT
MODESTO, CA 95356-0116
Phone number:
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