Healthcare Provider Details

I. General information

NPI: 1134424054
Provider Name (Legal Business Name): DEBORAH RAE WALACH MA, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MS. DEBORAH RAE YELLE

II. Dates (important events)

Enumeration Date: 01/25/2011
Last Update Date: 03/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9258 CULEBRA RD SUITE 103-3
SAN ANTONIO TX
78251-2871
US

IV. Provider business mailing address

5203 SAVANNAH CT
VON ORMY TX
78073-3002
US

V. Phone/Fax

Practice location:
  • Phone: 888-760-3390
  • Fax: 888-760-3390
Mailing address:
  • Phone: 910-526-6237
  • Fax: 210-624-3480

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number63642
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: