Provider Demographics
NPI:1013471853
Name:MARK ALLEN WALLMAN, SR.
Entity Type:Organization
Organization Name:MARK ALLEN WALLMAN, SR.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PROFESSIONAL COUNSELOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:WALLMAN
Authorized Official - Suffix:SR
Authorized Official - Credentials:LPC
Authorized Official - Phone:214-218-4356
Mailing Address - Street 1:1920 GRASSMERE LN APT 1012
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75071-8534
Mailing Address - Country:US
Mailing Address - Phone:214-218-4356
Mailing Address - Fax:
Practice Address - Street 1:5850 TOWN AND COUNTRY BLVD
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-6942
Practice Address - Country:US
Practice Address - Phone:214-218-4356
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-25
Last Update Date:2019-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)