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: |