| Doctor Name: | MICHAEL WAYNE WALLINGTON |
| NPI Number: | 1154477404 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | LPCC |
| License Number: | 2331 |
| Business Practice Address: | 904 E Fairview Ln # B Espanola, NM - 875322822 |
| Business Phone Number: | 5057471991 |
| Business Fax Number: | 5057536462 |
| Mailing Address: | Po Box Kk, TAOS |
| State: | NM |
| Postal Code: | 875711570 |
| Phone Number: | 5057517037 |
| Fax Number: | 5057513010 |
| NPI Enumeration Date: | 01/26/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | 2331 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NM |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |