Provider Demographics
NPI:1558464495
Name:WALLIN, BRIAN LEROY
Entity type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:LEROY
Last Name:WALLIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3234 S SERENITY TRL
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57103-6576
Mailing Address - Country:US
Mailing Address - Phone:605-275-0864
Mailing Address - Fax:
Practice Address - Street 1:SIOUX FALLS VA MEDICAL CENTER, 2501 W. 22ND STREET
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57117-5046
Practice Address - Country:US
Practice Address - Phone:605-336-3230
Practice Address - Fax:605-333-6804
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor