Provider Demographics
NPI:1124431515
Name:WALLIS, BARBARA J (LPCC-SUPV)
Entity type:Individual
Prefix:
First Name:BARBARA
Middle Name:J
Last Name:WALLIS
Suffix:
Gender:F
Credentials:LPCC-SUPV
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 W 3RD ST
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:OH
Mailing Address - Zip Code:44622-2934
Mailing Address - Country:US
Mailing Address - Phone:330-343-6600
Mailing Address - Fax:330-343-6405
Practice Address - Street 1:130 W 3RD ST
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:OH
Practice Address - Zip Code:44622-2934
Practice Address - Country:US
Practice Address - Phone:330-343-6600
Practice Address - Fax:330-343-6405
Is Sole Proprietor?:No
Enumeration Date:2014-06-04
Last Update Date:2017-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE.0600069 SUPV101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional