Provider Demographics
NPI:1982234639
Name:WALLER, JULIE
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:WALLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 TEWA CT
Mailing Address - Street 2:
Mailing Address - City:SANDIA PARK
Mailing Address - State:NM
Mailing Address - Zip Code:87047-8523
Mailing Address - Country:US
Mailing Address - Phone:281-541-2189
Mailing Address - Fax:
Practice Address - Street 1:770 S POST OAK LN STE 320
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77056-1938
Practice Address - Country:US
Practice Address - Phone:714-274-7577
Practice Address - Fax:714-274-7578
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-22
Last Update Date:2025-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX86614101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty