Provider Demographics
NPI:1801859632
Name:WALLHERMFECHTEL, JAMES HERMAN (PHD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:HERMAN
Last Name:WALLHERMFECHTEL
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 1:1154 ALBANY CT
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63119-4733
Mailing Address - Country:US
Mailing Address - Phone:314-961-0475
Mailing Address - Fax:
Practice Address - Street 1:MENTAL HEALTH 116AJB
Practice Address - Street 2:ONE JEFFERSON BARRACKS
Practice Address - City:ST. LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63125
Practice Address - Country:US
Practice Address - Phone:314-894-6562
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO00874103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical