Provider Demographics
NPI:1134424054
Name:WALACH, DEBORAH RAE (MA, LPC)
Entity type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:RAE
Last Name:WALACH
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:MS
Other - First Name:DEBORAH
Other - Middle Name:RAE
Other - Last Name:YELLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5203 SAVANNAH CT
Mailing Address - Street 2:
Mailing Address - City:VON ORMY
Mailing Address - State:TX
Mailing Address - Zip Code:78073-3002
Mailing Address - Country:US
Mailing Address - Phone:910-526-6237
Mailing Address - Fax:210-624-3480
Practice Address - Street 1:9258 CULEBRA RD
Practice Address - Street 2:SUITE 103-3
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78251-2871
Practice Address - Country:US
Practice Address - Phone:888-760-3390
Practice Address - Fax:888-760-3390
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-25
Last Update Date:2013-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX63642101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional