Provider Demographics
NPI:1801200159
Name:WALLS, WILLIAM (MA)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:
Last Name:WALLS
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:731 N WEBER ST
Mailing Address - Street 2:SUITE 205
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80903-1049
Mailing Address - Country:US
Mailing Address - Phone:719-339-6147
Mailing Address - Fax:
Practice Address - Street 1:731 N WEBER ST
Practice Address - Street 2:SUITE 205
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80903-1049
Practice Address - Country:US
Practice Address - Phone:719-339-6147
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-15
Last Update Date:2016-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPC.0013254101YM0800X
COACD.0000681101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)