Individual
DAVID WALL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CFLE
Contact information
Practice address
622 MISSOURI ST, LIBERTY, TX 77575-4622
(409) 767-5859
Mailing address
622 MISSOURI ST, LIBERTY, TX 77575-4622
(409) 767-5859
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
12/15/2020
Last updated
12/15/2020
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