Healthcare Provider Details

I. General information

NPI: 1982234639
Provider Name (Legal Business Name): JULIE WALLER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/22/2020
Last Update Date: 07/29/2025
Certification Date: 07/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

770 S POST OAK LN STE 320
HOUSTON TX
77056-1938
US

IV. Provider business mailing address

8 TEWA CT
SANDIA PARK NM
87047-8523
US

V. Phone/Fax

Practice location:
  • Phone: 714-274-7577
  • Fax: 714-274-7578
Mailing address:
  • Phone: 281-541-2189
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number86614
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: