| Doctor Name: | DARIN JOSEPH WALLIS |
| NPI Number: | 1033355797 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | LMFT, LCSW, CAC III |
| License Number: | 426 |
| Business Practice Address: | 4891 Independence St Suite 165 Wheat Ridge, CO - 800336752 |
| Business Phone Number: | 3034560600 |
| Business Fax Number: | 3034560607 |
| Mailing Address: | 4891 Independence St, Suite 165 WHEAT RIDGE |
| State: | CO |
| Postal Code: | 800336752 |
| Phone Number: | 3034560600 |
| Fax Number: | 3034560607 |
| NPI Enumeration Date: | 12/31/2008 |
| NPI Last Update Date: | 01/15/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | 426 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | CO |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |