Provider Demographics
NPI:1578633731
Name:KIRSI NLEMELA-WALLER
Entity Type:Organization
Organization Name:KIRSI NLEMELA-WALLER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KIRSI
Authorized Official - Middle Name:
Authorized Official - Last Name:NLEMELA-WALLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-543-3704
Mailing Address - Street 1:1006 N BOWEN RD
Mailing Address - Street 2:SUITE 124
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76012-2826
Mailing Address - Country:US
Mailing Address - Phone:817-543-3704
Mailing Address - Fax:
Practice Address - Street 1:1006 N BOWEN RD
Practice Address - Street 2:SUITE 124
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76012-2826
Practice Address - Country:US
Practice Address - Phone:817-543-3704
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2008-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX30882103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty