1568592533 NPI number — LOU ANN WALLIS, LPC, PC

Table of content: HANA LEIA TAFARELLA RN (NPI 1194469866)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568592533 NPI number — LOU ANN WALLIS, LPC, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LOU ANN WALLIS, LPC, PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1568592533
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
468 S SEGUIN AVE
Provider Second Line Business Mailing Address:
STE. 401
Provider Business Mailing Address City Name:
NEW BRAUNFELS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78130-7664
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
830-822-5054
Provider Business Mailing Address Fax Number:
830-629-9700

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
468 S SEGUIN AVE
Provider Second Line Business Practice Location Address:
STE. 401
Provider Business Practice Location Address City Name:
NEW BRAUNFELS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78130-7664
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
830-822-5054
Provider Business Practice Location Address Fax Number:
830-629-9700
Provider Enumeration Date:
03/07/2007

Additional Information

Authorized Official

Authorized Official Last Name:
WALLIS
Authorized Official First Name:
LOUANN
Authorized Official Middle Name:
C
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
830-822-5054

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  15933 , 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)

  • Identifier: 1167146 . This is a "INSURANCE PROVIDER ID" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 232854 . This is a "INSURANCE PROVIDER ID" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 239642 . This is a "INSURANCE PROVIDER ID" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 12471 . This is a "INSURANCE PROVIDER ID" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 1508894783 . This is a "INDIV. NPI" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 506801 . This is a "INSURANCE PROVIDER ID" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 5096LC . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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