| Doctor Name: | ANDREW R WALL |
| NPI Number: | 1376899799 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | LCPC |
| License Number: | 180008228 |
| Business Practice Address: | 2302 W North Ave Unit 1e Chicago, IL - 606476260 |
| Business Phone Number: | 7735517204 |
| Business Fax Number: | 7733424200 |
| Mailing Address: | 2302 W North Ave, Unit 1e CHICAGO |
| State: | IL |
| Postal Code: | 606476260 |
| Phone Number: | 7735517204 |
| Fax Number: | 7733424200 |
| NPI Enumeration Date: | 08/03/2012 |
| NPI Last Update Date: | 10/02/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101Y00000X |
| License Number: | 180008228 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | IL |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A provider who is trained and educated in the performance of behavior health services through interpersonal communications and analysis. Training and education at the specialty level usually requires a master |