Provider Demographics
NPI:1124831870
Name:WALLS, SARA GENEVIEVE (LPC-ASSOCIATE)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:GENEVIEVE
Last Name:WALLS
Suffix:
Gender:F
Credentials:LPC-ASSOCIATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8001 TANTARA CT
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78729-6452
Mailing Address - Country:US
Mailing Address - Phone:512-468-6545
Mailing Address - Fax:
Practice Address - Street 1:4361 S CONGRESS AVE UNIT 102
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78745-1289
Practice Address - Country:US
Practice Address - Phone:512-772-3611
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-28
Last Update Date:2025-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX94590101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional