Individual
DEREK JUSTIN WALL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.S., LPC, NCC
Contact information
Practice address
12400 OLIVE BLVD, SUITE 205, SAINT LOUIS, MO 63141-5454
(314) 607-2801
Mailing address
13211 WINDYGATE LN, SAINT LOUIS, MO 63146-2227
(314) 607-2801
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
180.007223
IL
101YP2500X
Professional Counselor
Primary
2009035484
MO
Other
Enumeration date
12/10/2009
Last updated
12/10/2009
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