Individual
JOHN ROBERT WALLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
L.P.C.
Contact information
Practice address
3901 E BOGARD RD, WASILLA, AK 99654-6068
(907) 376-0459
(907) 376-0493
Mailing address
1825 S CHUGACH ST, PALMER, AK 99645-6795
(907) 746-4080
(907) 746-1177
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
AA450
AK
Other
Enumeration date
11/11/2008
Last updated
11/11/2008
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