| Doctor Name: | DR. BYRON WALLER |
| NPI Number: | 1013064328 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PH.D. |
| License Number: | |
| Business Practice Address: | 401 E 162nd St Suite 109 South Holland, IL - 604732236 |
| Business Phone Number: | 7083392769 |
| Business Fax Number: | |
| Mailing Address: | 25140 Spring St, MANHATTAN |
| State: | IL |
| Postal Code: | 604421403 |
| Phone Number: | 8154789648 |
| Fax Number: | |
| NPI Enumeration Date: | 01/05/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101Y00000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | X |
| State: | IL |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A provider who is trained and educated in the performance of behavior health services through interpersonal communications and analysis. Training and education at the specialty level usually requires a master |