Provider Demographics
NPI:1699201202
Name:WALLECK, LINDSAY (LPC)
Entity Type:Individual
Prefix:
First Name:LINDSAY
Middle Name:
Last Name:WALLECK
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 1:2912 LITTLE RD
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76016-1725
Mailing Address - Country:US
Mailing Address - Phone:817-457-6728
Mailing Address - Fax:817-451-7732
Practice Address - Street 1:2912 LITTLE RD
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76016-1725
Practice Address - Country:US
Practice Address - Phone:817-457-6728
Practice Address - Fax:817-451-7732
Is Sole Proprietor?:No
Enumeration Date:2017-05-03
Last Update Date:2017-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX68670101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional