MEDICARE: MONICA DANIELLE WALLING LMHC

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
1	101YM0800X	Mental Health Counselor	14860	FL

General Provider Information

NPI Number	:	1942740865
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MONICA DANIELLE WALLING LMHC

Provider Business Mailing Address
First Line	:	6107 S DIXIE HWY STE 3
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33405-4050
Country	:	US
Telephone Number	:	561-301-8787
Fax Number	:

Provider Business Practice Location Address
First Line	:	6107 S DIXIE HWY STE 3
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33405
Country	:	US
Telephone Number	:	561-301-8787
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/24/2017
Last Update Date	:	06/11/2019

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