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General NPI Number Information
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NPI Number | 1134942030
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Entity Type | Individual
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Provider Name | MARIAH WALL PSY. S., NCSP
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Gender | Female
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Dates
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Enumeration Date | 11/07/2024
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Last Update Date | 11/07/2024
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Provider Practice Location Address
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Address Line | 158 STATE RD 531 BLDG B
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City | TIERRA AMARILLA
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State | NM
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Zip | 87575
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Country | US
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Telephone | 575-588-7285
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Fax |
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Provider Business Mailing Address
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Address Line | 3415 BOQUILLAS CT
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City | KATY
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State | TX
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Zip | 77494-1391
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TS0200X
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Taxonomy Name | School Psychologist
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License Number |
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License Number State |
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