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NPI Code Detail

MEDICARE: MR. WILLIAM REGIS WALL JR. M.ED.

MEDICARE: MR. WILLIAM REGIS WALL JR. M.ED.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TC1900XCounseling Psychologist

General Provider Information

NPI Number : 1063645422
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. WILLIAM REGIS WALL JR. M.ED.
Provider Business Mailing Address
First Line : 4750 N CENTRAL AVE
Second Line : UNIT 14N
City : PHOENIX
State : AZ
Zip : 85012-1732
Country : US
Telephone Number : 602-243-4866
Fax Number :
Provider Business Practice Location Address
First Line : 6218 S 7TH ST
Second Line :
City : PHOENIX
State : AZ
Zip : 85042-4211
Country : US
Telephone Number : 602-304-3117
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/01/2009
Last Update Date : 02/15/2026

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