Provider Demographics
NPI:1427678572
Name:LEWALLEN, VICTORIA LEIGH (LPC, LSOTP)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:LEIGH
Last Name:LEWALLEN
Suffix:
Gender:F
Credentials:LPC, LSOTP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 CHISHOLM TRAIL RD STE 450
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78681-5094
Mailing Address - Country:US
Mailing Address - Phone:817-565-7596
Mailing Address - Fax:512-503-3991
Practice Address - Street 1:1 CHISHOLM TRAIL RD STE 450
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78681-5094
Practice Address - Country:US
Practice Address - Phone:817-565-7596
Practice Address - Fax:512-503-3991
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-18
Last Update Date:2022-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX77468101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor