Provider Demographics
NPI:1386830255
Name:WALLS, LAZANE SHERILYN (LPC)
Entity Type:Individual
Prefix:MRS
First Name:LAZANE
Middle Name:SHERILYN
Last Name:WALLS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MRS
Other - First Name:LAZANE
Other - Middle Name:SHERILYN
Other - Last Name:WALLS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCDC
Mailing Address - Street 1:1380 RIVER BEND DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75247-4914
Mailing Address - Country:US
Mailing Address - Phone:214-743-6159
Mailing Address - Fax:214-689-6482
Practice Address - Street 1:3330 S LANCASTER RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75216-4531
Practice Address - Country:US
Practice Address - Phone:214-371-6639
Practice Address - Fax:214-372-6199
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-24
Last Update Date:2012-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8802101YA0400X
TX15910101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1386830255Medicaid