Provider Demographics
NPI:1568592533
Name:LOU ANN WALLIS, LPC, PC
Entity Type:Organization
Organization Name:LOU ANN WALLIS, LPC, PC
Other - Org Name:LIFECORDS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:LOUANN
Authorized Official - Middle Name:C
Authorized Official - Last Name:WALLIS
Authorized Official - Suffix:
Authorized Official - Credentials:MED, LPC
Authorized Official - Phone:830-822-5054
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15933101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1167146OtherINSURANCE PROVIDER ID
TX232854OtherINSURANCE PROVIDER ID
TX239642OtherINSURANCE PROVIDER ID
TX12471OtherINSURANCE PROVIDER ID
TX1508894783OtherINDIV. NPI
TX506801OtherINSURANCE PROVIDER ID
TX5096LCOtherBLUE CROSS BLUE SHIELD