Provider Demographics
NPI:1326487646
Name:WALLE, HEIDI (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:HEIDI
Middle Name:
Last Name:WALLE
Suffix:
Gender:F
Credentials:LMFT
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 995
Mailing Address - Street 2:
Mailing Address - City:COARSEGOLD
Mailing Address - State:CA
Mailing Address - Zip Code:93614-0995
Mailing Address - Country:US
Mailing Address - Phone:559-760-4757
Mailing Address - Fax:559-641-2359
Practice Address - Street 1:49370 ROAD 426
Practice Address - Street 2:SUITE C
Practice Address - City:OAKHURST
Practice Address - State:CA
Practice Address - Zip Code:93644-9051
Practice Address - Country:US
Practice Address - Phone:559-760-4757
Practice Address - Fax:559-641-2359
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-19
Last Update Date:2013-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist