Provider Demographics
NPI:1700529518
Name:DESIDELICS, PLLC
Entity Type:Organization
Organization Name:DESIDELICS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DESMOND
Authorized Official - Middle Name:
Authorized Official - Last Name:WALLINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:405-714-2999
Mailing Address - Street 1:2254 N HIGH ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80205-5560
Mailing Address - Country:US
Mailing Address - Phone:405-714-2999
Mailing Address - Fax:
Practice Address - Street 1:2254 N HIGH ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80205-5560
Practice Address - Country:US
Practice Address - Phone:405-714-2999
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-19
Last Update Date:2022-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty