Derek Justin Wall M.S., LPC, NCC

NPI 1639408214 - Counselor - 101YP2500X

NPI Details
NPI 1639408214
Gender Male
Enumeration Date 12/10/2009
Last Updated 12/10/2009
Entity Type Individual
Active Over 7 years ago
Practice Location
12400 OLIVE BLVD
SUITE 205
SAINT LOUIS MO, 63141-5454, US
Phone (314) 607-2801
Fax
Business Location
13211 WINDYGATE LN
SAINT LOUIS MO, 63146-2227, US
Phone (314) 607-2801
Fax
Toxanomy
Taxonomy Code 101YP2500X
License State Illinois
License Number 180.007223
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According to our database, Derek Justin Wall M.S., LPC, NCC NPI is 1639408214, taxonomy code is 101YP2500X and license number is 180.007223, license state is located at Illinois. Derek Justin Wall M.S., LPC, NCC physically located at 12400 Olive Blvd, Saint Louis MO, 63141-5454. NPI Number Derek Justin Wall M.S., LPC, NCC has the Individual type.

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1639408214 NPI number is provided on an as is basis without warranty of any kind. 1639408214 is maintained by the National Plan & Provider Enumeration System. The contents of Derek Justin Wall M.S., LPC, NCC are for informational purposes only.