Provider Demographics
NPI:1538254115
Name:WALLING, DAVID PRESTON (PHD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:PRESTON
Last Name:WALLING
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12772 VALLEY VIEW ST.
Mailing Address - Street 2:SUITE 3
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92845-2506
Mailing Address - Country:US
Mailing Address - Phone:714-799-7799
Mailing Address - Fax:714-799-1633
Practice Address - Street 1:12772 VALLEY VIEW ST.
Practice Address - Street 2:SUITE 3
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92845-2506
Practice Address - Country:US
Practice Address - Phone:714-799-7799
Practice Address - Fax:714-799-1633
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16657103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist