Provider Demographics
NPI:1699137083
Name:CONNALLY, WALLISA (LCSW)
Entity type:Individual
Prefix:MRS
First Name:WALLISA
Middle Name:
Last Name:CONNALLY
Suffix:
Gender:
Credentials:LCSW
Other - Prefix:
Other - First Name:WALLISA
Other - Middle Name:
Other - Last Name:SHEEHY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:105 RICKER WAY
Mailing Address - Street 2:
Mailing Address - City:LIBERTY HILL
Mailing Address - State:TX
Mailing Address - Zip Code:78642-2156
Mailing Address - Country:US
Mailing Address - Phone:254-423-3312
Mailing Address - Fax:
Practice Address - Street 1:BLDG 2255 TANK DESTROYER BLVD
Practice Address - Street 2:
Practice Address - City:FORT HOOD
Practice Address - State:TX
Practice Address - Zip Code:76544
Practice Address - Country:US
Practice Address - Phone:254-288-6474
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-24
Last Update Date:2025-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX392441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical