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NPI Code Detail

MEDICARE: BARBARA J WALLIS LPCC-SUPV

MEDICARE: BARBARA J WALLIS LPCC-SUPV
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
1101YP2500XProfessional CounselorE.0600069 SUPVOH

General Provider Information

NPI Number : 1124431515
Entity Type Code : Individual
Provider Name (Legal Business Name) : BARBARA J WALLIS LPCC-SUPV
Provider Business Mailing Address
First Line : 130 W 3RD ST
Second Line :
City : DOVER
State : OH
Zip : 44622-2934
Country : US
Telephone Number : 330-343-6600
Fax Number : 330-343-6405
Provider Business Practice Location Address
First Line : 130 W 3RD ST
Second Line :
City : DOVER
State : OH
Zip : 44622-2934
Country : US
Telephone Number : 330-343-6600
Fax Number : 330-343-6405
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/04/2014
Last Update Date : 04/05/2017

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Directions to “ BARBARA J WALLIS LPCC-SUPV” Practice Location

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