Individual
JASON W WALLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MA, LPC
Contact information
Practice address
3127 QUINBY DR, COLUMBUS, OH 43232-7734
(765) 586-6894
Mailing address
3127 QUINBY DR, COLUMBUS, OH 43232-7734
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
C.2305477
OH
Other
Enumeration date
09/14/2023
Last updated
09/14/2023
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