Christine Nicole Bracamontes Ballance, MA, LCPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

180011136 Issued in IL

Practice address

226 S Morrison Ave
Collinsville, IL 62234-2711

Phone

(618) 514-4842

Fax

(618) 514-4842

NPI assigned

Sep 7, 2017

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Christine Bracamontes Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Arts

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1504742400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1553472000000",
    "number": "1982122214",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "226 S MORRISON AVE",
            "city": "COLLINSVILLE",
            "state": "IL",
            "postal_code": "622342711",
            "telephone_number": "618-514-4842",
            "fax_number": "618-514-4842"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "226 S MORRISON AVE",
            "city": "COLLINSVILLE",
            "state": "IL",
            "postal_code": "622342711",
            "telephone_number": "618-514-4842",
            "fax_number": "618-514-4842"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "226 S Morrison Ave",
            "address_purpose": "LOCATION",
            "city": "Collinsville",
            "state": "IL",
            "postal_code": "622342711",
            "country_code": "US",
            "telephone_number": "618-514-4842",
            "fax_number": "618-514-4842",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BALLANCE",
        "first_name": "CHRISTINE",
        "middle_name": "NICOLE BRACAMONTES",
        "credential": "MA, LCPC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-09-07",
        "last_updated": "2019-03-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "IL",
            "license": "180011136",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CHRISTINE",
            "last_name": "BRACAMONTES",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Professional Counselor in Collinsville, IL
• Providers in Collinsville, IL by specialty
• Professional Counselor in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 25, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.