Provider Demographics
NPI:1821487851
Name:WALLIS, BRITTANY (LMFT)
Entity Type:Individual
Prefix:
First Name:BRITTANY
Middle Name:
Last Name:WALLIS
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 MAJORCA AVE
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-4508
Mailing Address - Country:US
Mailing Address - Phone:786-618-2627
Mailing Address - Fax:786-685-2126
Practice Address - Street 1:101 MAJORCA AVE
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-4508
Practice Address - Country:US
Practice Address - Phone:786-618-2627
Practice Address - Fax:786-685-2126
Is Sole Proprietor?:No
Enumeration Date:2015-01-14
Last Update Date:2022-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT#2950106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist