Individual provider · Type 1 NPI

Derek Justin Wall, M.S., LPC, NCC

Professional Counselor · St. Louis, MO

NPI number 1639408214 Active

Practice location

12400 Olive Blvd, Suite 205
St. Louis, MO 63141-5454

Call (314) 607-2801 Map

Mailing address

13211 Windygate Ln
St. Louis, MO 63146-2227

Specialties and licenses

TaxonomyCodeLicense
Professional Counselor Primary 101YP2500X2009035484 (MO)
Professional Counselor 101YP2500X180.007223 (IL)

Professional Counselor: Definition to come...

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About NPI 1639408214

Derek Justin Wall, M.S., LPC, NCC's National Provider Identifier is 1639408214, issued on Dec 10, 2009. The primary taxonomy on file is Professional Counselor (101YP2500X), and the practice location is in St. Louis, MO. The record was last updated on Dec 10, 2009.