| Doctor Name: | MR. DONNIE M. WALLER |
| NPI Number: | 1013020957 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | LSW |
| License Number: | 1775 |
| Business Practice Address: | 112 Mckinley Ave Chandler, OK - 748341622 |
| Business Phone Number: | 4052583040 |
| Business Fax Number: | 4052405008 |
| Mailing Address: | Rr 2 Box 220b, MEEKER |
| State: | OK |
| Postal Code: | 748559305 |
| Phone Number: | 4052149667 |
| Fax Number: | |
| NPI Enumeration Date: | 08/16/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | 1775 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OK |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |