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General NPI Number Information
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NPI Number | 1942290366
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Entity Type | Individual
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Provider Name | GEORGE L WALLACE-BARNHILL PHD LMHC
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Gender | Male
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Dates
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Enumeration Date | 10/26/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1323 SE 4TH AVE STE B16
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City | FT LAUDERDALE
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State | FL
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Zip | 33316
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Country | US
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Telephone | 954-832-0998
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Fax | 954-467-8439
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Provider Business Mailing Address
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Address Line | 10315 SW 53RD ST
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City | COOPER CITY
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State | FL
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Zip | 33328
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Country | US
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Telephone | 954-832-0998
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MH000574
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License Number State | FL
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