Provider Demographics
NPI:1790847846
Name:ALLBERG, WALTER RAY (PHD)
Entity Type:Individual
Prefix:DR
First Name:WALTER
Middle Name:RAY
Last Name:ALLBERG
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1820 ARNOLD PALMER DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79935-3024
Mailing Address - Country:US
Mailing Address - Phone:915-598-9310
Mailing Address - Fax:
Practice Address - Street 1:1605 BEECH ST STE B
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79925-1101
Practice Address - Country:US
Practice Address - Phone:915-778-2458
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX24260103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00L21AMedicare ID - Type Unspecified