1134424054 NPI number — MRS. DEBORAH RAE WALACH MA, LPC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134424054 NPI number — MRS. DEBORAH RAE WALACH MA, LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WALACH
Provider First Name:
DEBORAH
Provider Middle Name:
RAE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MA, LPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
YELLE
Provider Other First Name:
DEBORAH
Provider Other Middle Name:
RAE
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1134424054
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/25/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5203 SAVANNAH CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VON ORMY
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78073-3002
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
910-526-6237
Provider Business Mailing Address Fax Number:
210-624-3480

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9258 CULEBRA RD
Provider Second Line Business Practice Location Address:
SUITE 103-3
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78251-2871
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
888-760-3390
Provider Business Practice Location Address Fax Number:
888-760-3390
Provider Enumeration Date:
01/25/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  63642 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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