Doctor Name: | DR. HERBERT MAC WALLING |
NPI Number: | 1154445492 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | PHD |
License Number: | 24102 |
Business Practice Address: | 1201 W Industrial Sulphur Springs, TX - 75482 |
Business Phone Number: | 9038859803 |
Business Fax Number: | 9034396243 |
Mailing Address: | Po Box 362, SULPHUR SPRINGS |
State: | TX |
Postal Code: | 754830362 |
Phone Number: | 9038859803 |
Fax Number: | 9034396243 |
NPI Enumeration Date: | 03/19/2007 |
NPI Last Update Date: | 07/21/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TC0700X |
License Number: | 24102 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | TX |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: |