Individual
MR. AUSTIN TANAKA WALLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
995 GATEWAY CENTER WAY STE 300, SAN DIEGO, CA 92102-4550
(619) 398-2168
(619) 398-2168
Mailing address
995 GATEWAY CENTER WAY STE 300, SAN DIEGO, CA 92102-4550
(193) 982-1566
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
103K00000X
Behavior Analyst
F5130372
CA
171M00000X
Case Manager/Care Coordinator
—
—
225C00000X
Rehabilitation Counselor
Primary
—
CA
Other
Enumeration date
06/20/2018
Last updated
03/27/2025
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