Individual ProviderAngela BallantyneCounselorBehavioral Health & Social Service ProvidersPractice Address1601 E 4th Plain Blvd Bldg 17, Vancouver, WA 98661-3717(360) 397-8246(503) 602-2461PECOS EnrollmentBased on the most recent information from CMS, provider Angela Ballantyne does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records yesterday at 10:04 AM.Profile DetailsProvider ID1194388199Provider TypeIndividualFull NameBallantyne, AngelaGenderFemaleSole ProprietorYesEnumeration Date4/16/2019Last Updated4/16/2019Contact InformationPractice LocationPractice Address1601 E 4th Plain Blvd Bldg 17, Vancouver, WA 98661-3717Phone(360) 397-8246FaxUnlisted FaxMailing LocationMailing Address2809 NE 97th Way, Vancouver, WA 98665-5710Phone(503) 602-2461FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode101YM0800XPrimaryDescriptionCounselorBehavioral Health & Social Service ProvidersLicenseUnlisted Issuer