Provider Demographics
NPI:1508894783
Name:WALLIS, LOUANN C (LPC)
Entity Type:Individual
Prefix:
First Name:LOUANN
Middle Name:C
Last Name:WALLIS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:468 S SEGUIN AVE
Mailing Address - Street 2:STE. 401
Mailing Address - City:NEW BRAUNFELS
Mailing Address - State:TX
Mailing Address - Zip Code:78130-7664
Mailing Address - Country:US
Mailing Address - Phone:830-822-5054
Mailing Address - Fax:830-629-9700
Practice Address - Street 1:468 S SEGUIN AVE
Practice Address - Street 2:STE. 401
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78130-7664
Practice Address - Country:US
Practice Address - Phone:830-822-5054
Practice Address - Fax:830-629-9700
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15933101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX5096LCOtherBLUECROSSBLUESHIELD
TX1167146OtherCIGNA BEHAVIORAL HEALTH
TX232854OtherCOMPSYCH
TX239642OtherMHN
TX506801OtherMHS# VALUE OPTIONS
TX12471OtherCOMMUNITY FIRST HEALTH PL