Provider Demographics
NPI:1073249033
Name:WALLS, TAMERA
Entity Type:Individual
Prefix:
First Name:TAMERA
Middle Name:
Last Name:WALLS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2760 AIRPORT DR STE 130A
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43219-2473
Mailing Address - Country:US
Mailing Address - Phone:614-306-8134
Mailing Address - Fax:614-351-2010
Practice Address - Street 1:2760 AIRPORT DR STE 130A
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43219-2473
Practice Address - Country:US
Practice Address - Phone:614-407-9047
Practice Address - Fax:614-351-2010
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-01
Last Update Date:2022-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH101Y00000X, 171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101Y00000XBehavioral Health & Social Service ProvidersCounselor