Provider Demographics
NPI:1700099256
Name:WALLS, EMILY MEGAN
Entity Type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:MEGAN
Last Name:WALLS
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:EMILY
Other - Middle Name:MEGAN
Other - Last Name:TITUS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:468 COUNTY ROAD 11
Mailing Address - Street 2:
Mailing Address - City:BELLEFONTAINE
Mailing Address - State:OH
Mailing Address - Zip Code:43311-9260
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:468 COUNTY ROAD 11
Practice Address - Street 2:
Practice Address - City:BELLEFONTAINE
Practice Address - State:OH
Practice Address - Zip Code:43311-9260
Practice Address - Country:US
Practice Address - Phone:937-599-4644
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health