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NPI Code Detail

MEDICARE: BILL WALLS IV

MEDICARE: BILL WALLS IV
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
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1881291557
Entity Type Code : Individual
Provider Name (Legal Business Name) : BILL WALLS IV
Provider Business Mailing Address
First Line : 130 W FLORA ST
Second Line :
City : STOCKTON
State : CA
Zip : 95202-1636
Country : US
Telephone Number : 209-658-2448
Fax Number :
Provider Business Practice Location Address
First Line : 130 W FLORA ST
Second Line :
City : STOCKTON
State : CA
Zip : 95202-1636
Country : US
Telephone Number : 209-658-2448
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/06/2020
Last Update Date : 10/06/2020

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Directions to “ BILL WALLS IV ” Practice Location

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