Waller, Mark Richard
Waller, Mark Richard is an sole proprietor health care provider with primary practice located at 851 W Morton Ave Suite A, Porterville CA 93257-3185. He recently has only one registered license in Behavioral Health & Social Service Providers / Marriage & Family Therapist, which is considered as his primary health care specialty. Waller, Mark Richard can be contacted via phone (888) 401-6275.Contact Information
Primary practice address
851 W Morton Ave Suite A
Porterville CA 93257-3185
Phone: (888) 401-6275
Fax: (888) 401-6275
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Behavioral Health & Social Service Providers / Marriage & Family Therapist | 106H00000X | 36233 | California |
Profile Details
| NPI number | 1356521942 |
|---|---|
| LBN Legal business name | Waller, Mark Richard |
| Credentials | PH.D., MFT |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Nov 12th, 2007 |
| Last updated | May 4th, 2009 - about 17 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1356521942 | NPPES |
| California | Other | 36233 | STATE LICENSE NUMBER |
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