Provider Demographics
NPI:1154445492
Name:WALLING, HERBERT MAC (PHD)
Entity Type:Individual
Prefix:DR
First Name:HERBERT
Middle Name:MAC
Last Name:WALLING
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 362
Mailing Address - Street 2:
Mailing Address - City:SULPHUR SPRINGS
Mailing Address - State:TX
Mailing Address - Zip Code:75483-0362
Mailing Address - Country:US
Mailing Address - Phone:903-885-9803
Mailing Address - Fax:903-439-6243
Practice Address - Street 1:1201 W INDUSTRIAL
Practice Address - Street 2:
Practice Address - City:SULPHUR SPRINGS
Practice Address - State:TX
Practice Address - Zip Code:75482
Practice Address - Country:US
Practice Address - Phone:903-885-9803
Practice Address - Fax:903-439-6243
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2010-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX24102103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX24102OtherTX STATE BOARD EXAMINER
TX114787801Medicaid
TX24102OtherTX STATE BOARD EXAMINER