| Doctor Name: | MRS. JANICE LEE WALLER |
| NPI Number: | 1326142969 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MED, CMHT |
| License Number: | |
| Business Practice Address: | 339 Legion Ln Pontotoc, MS - 388638978 |
| Business Phone Number: | 6625099300 |
| Business Fax Number: | 6625096698 |
| Mailing Address: | 69 County Road 311, OXFORD |
| State: | MS |
| Postal Code: | 386558533 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 09/12/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |