Provider Demographics
NPI:1982234639
Name:WALLER, JULIE
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:WALLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10951 LITHOPOLIS RD NW APT C
Mailing Address - Street 2:
Mailing Address - City:CANAL WINCHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:43110-7865
Mailing Address - Country:US
Mailing Address - Phone:281-541-2189
Mailing Address - Fax:
Practice Address - Street 1:85 E GAY ST STE 800
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43215-3118
Practice Address - Country:US
Practice Address - Phone:614-805-2129
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-22
Last Update Date:2020-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health