MEDICARE: ABBY WALLS LPCC-S

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	C2203941	OH

General Provider Information

NPI Number	:	1013508829
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ABBY WALLS LPCC-S

Provider Business Mailing Address
First Line	:	1370 N FAIRFIELD RD STE B
Second Line	:
City	:	BEAVERCREEK
State	:	OH
Zip	:	45432-2682
Country	:	US
Telephone Number	:	937-910-8739
Fax Number	:

Provider Business Practice Location Address
First Line	:	1370 N FAIRFIELD RD STE B
Second Line	:
City	:	BEAVERCREEK
State	:	OH
Zip	:	45432-2682
Country	:	US
Telephone Number	:	937-910-8739
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/03/2021
Last Update Date	:	01/06/2026

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