1568592533 NPI number — LOU ANN WALLIS, LPC, PC

Table of content: (NPI 1568592533)

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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