Provider Demographics
NPI:1174662563
Name:WALLING, MICHAEL C (LMHC, CEAP, SAP)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:C
Last Name:WALLING
Suffix:
Gender:M
Credentials:LMHC, CEAP, SAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 E PIONEER STE 201
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98372-3257
Mailing Address - Country:US
Mailing Address - Phone:253-864-8188
Mailing Address - Fax:253-864-8288
Practice Address - Street 1:400 E PIONEER STE 201
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98372-3257
Practice Address - Country:US
Practice Address - Phone:253-864-8188
Practice Address - Fax:253-864-8288
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
WALH00003889101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAWA1615OtherREGENCE BLUE SHIELD
WA1043590OtherCIGNA BERHAVIORAL HEALTH