Provider Demographics
NPI:1679445381
Name:WALLER, MORIAH (LPC)
Entity type:Individual
Prefix:
First Name:MORIAH
Middle Name:
Last Name:WALLER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2209 OKLAHOMA AVE
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75074-2069
Mailing Address - Country:US
Mailing Address - Phone:469-743-6633
Mailing Address - Fax:
Practice Address - Street 1:2209 OKLAHOMA AVE
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75074-2069
Practice Address - Country:US
Practice Address - Phone:469-743-6633
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-22
Last Update Date:2025-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX100034101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional