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General NPI Number Information
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NPI Number | 1437569324
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Entity Type | Individual
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Provider Name | NICHELLE M. WALL M. ED., LPC, CST-C
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Gender | Female
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Dates
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Enumeration Date | 05/01/2014
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Last Update Date | 03/16/2016
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Provider Practice Location Address
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Address Line | 1264 HARWOOD RD 175
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City | BEDFORD
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State | TX
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Zip | 76021-4267
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Country | US
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Telephone | 214-396-6503
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Fax | 469-359-6729
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Provider Business Mailing Address
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Address Line | 1169 N BURLESON BLVD 107 PMB 242
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City | BURLESON
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State | TX
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Zip | 76028-7011
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Country | US
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Telephone | 214-396-6503
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Fax | 469-359-6729
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 69796
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License Number State | TX
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