Provider Demographics
NPI:1477311934
Name:WILL-WALLACE, MERL ALLEN (MA)
Entity Type:Individual
Prefix:
First Name:MERL
Middle Name:ALLEN
Last Name:WILL-WALLACE
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6944 E TANQUE VERDE RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85715-5308
Mailing Address - Country:US
Mailing Address - Phone:833-272-7342
Mailing Address - Fax:
Practice Address - Street 1:6944 E TANQUE VERDE RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85715-5308
Practice Address - Country:US
Practice Address - Phone:833-272-7342
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-11
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health