Provider Demographics
NPI:1356472401
Name:WALL, KATHRYN L (MED, LPC)
Entity type:Individual
Prefix:MS
First Name:KATHRYN
Middle Name:L
Last Name:WALL
Suffix:
Gender:F
Credentials:MED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1221 ABRAMS RD.
Mailing Address - Street 2:STE 235
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75081-5581
Mailing Address - Country:US
Mailing Address - Phone:972-234-5770
Mailing Address - Fax:972-699-0414
Practice Address - Street 1:1221 ABRAMS RD
Practice Address - Street 2:STE 235
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75081-5581
Practice Address - Country:US
Practice Address - Phone:972-234-5770
Practice Address - Fax:972-699-0414
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13862101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional