Provider Demographics
NPI:1134384316
Name:WALLS, ALISON R (PSYD)
Entity type:Individual
Prefix:DR
First Name:ALISON
Middle Name:R
Last Name:WALLS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2808 TRAYLOR BLVD
Mailing Address - Street 2:
Mailing Address - City:ROCKPORT
Mailing Address - State:TX
Mailing Address - Zip Code:78382-6897
Mailing Address - Country:US
Mailing Address - Phone:719-244-1942
Mailing Address - Fax:
Practice Address - Street 1:2808 TRAYLOR BLVD
Practice Address - Street 2:
Practice Address - City:ROCKPORT
Practice Address - State:TX
Practice Address - Zip Code:78382-6897
Practice Address - Country:US
Practice Address - Phone:719-244-1942
Practice Address - Fax:844-315-4316
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-27
Last Update Date:2019-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX37735103G00000X, 103TR0400X, 103TC0700X
CO3017103TC0700X, 103TH0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitation
No103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealth
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3741977Medicaid