MEDICARE: MORIAH WALLER LPC

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	101YP2500X	Professional Counselor	100034	TX

General Provider Information

NPI Number	:	1679445381
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MORIAH WALLER LPC

Provider Business Mailing Address
First Line	:	2209 OKLAHOMA AVE
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75074-2069
Country	:	US
Telephone Number	:	469-743-6633
Fax Number	:

Provider Business Practice Location Address
First Line	:	2209 OKLAHOMA AVE
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75074-2069
Country	:	US
Telephone Number	:	469-743-6633
Fax Number	:

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

Provider Enumeration Date	:	09/22/2025
Last Update Date	:	09/22/2025

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Directions to “ MORIAH WALLER LPC” Practice Location

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