Herbert Mac Walling, PHD – Clinical Psychologist

Key facts

NPI: 1154445492
Entity type: Individual (NPI type 1)
Primary specialty: Clinical Psychologist 103TC0700X
License: 24102 (TX)
Practice address: 1201 W Industrial
Sulphur Springs, TX 75482
Phone: (903) 885-9803
Fax: (903) 439-6243
NPI assigned: Mar 19, 2007
Sex: Male
Sole proprietor: Yes

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Lakes Regional Mental Health Mental Retardation Center Community/Behavioral Health Agency · Terrell, TX · NPI 1881752715

Medicare reassignment NPD TX

Medicare Care Compare profile

Specialty: Clinical Psychologist
Education: Other, 1989
Medicare assignment: Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

1201 W Industrial
Sulphur Springs, TX 75482-3731
Phone (903) 885-9803

362 PO Box
Sulphur Springs, TX 75483

Medicare participation

Medicare fee-for-service enrollment: Enrolled in TX
Eligible to order & refer: Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No

Medicare enrollment records

Enrollment ID	State	Provider type	PAC ID	Details
I20110104000973	TX	Practitioner - Clinical Psychologist	0941499198	Reassigns benefits to 1 organization Practice locations: Sulphur Springs, TX

National Provider Directory

Medicare enrollment (NPD): Yes
Credentials: Doctor of Philosophy

State licenses

License	State	Type	Specialty
24102	TX	MD	Clinical Psychologist

Practice roles

Organization	Specialty	Status	New patients
Lakes Regional Mental Health Mental Retardation Center		Current since Jun 1, 2015	Accepting new patients

Locations

1300 W 16th St
Mt Pleasant, TX 75455
Phone (972) 524-4159

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Clinical Psychologist	103TC0700X	24102	TX	Yes

Addresses

Primary practice location

1201 W Industrial
Sulphur Springs, TX 75482

Mailing address

PO Box 362
Sulphur Springs, TX 75483-0362
Phone (903) 885-9803

Other identifiers

Identifier	Type	State	Issuer
24102	Other	TX	TX STATE BOARD EXAMINER
114787801	Medicaid	TX

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jul 21, 2010.

{
    "created_epoch": "1174262400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1279670400000",
    "number": "1154445492",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 362",
            "city": "SULPHUR SPRINGS",
            "state": "TX",
            "postal_code": "754830362",
            "telephone_number": "903-885-9803",
            "fax_number": "903-439-6243"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1201 W INDUSTRIAL",
            "city": "SULPHUR SPRINGS",
            "state": "TX",
            "postal_code": "75482",
            "telephone_number": "903-885-9803",
            "fax_number": "903-439-6243"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLING",
        "first_name": "HERBERT",
        "middle_name": "MAC",
        "name_prefix": "Dr.",
        "credential": "PHD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-03-19",
        "last_updated": "2010-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "TX",
            "license": "24102",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TX STATE BOARD EXAMINER",
            "identifier": "24102",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "114787801",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Sulphur Springs, TX

All providers in Sulphur Springs, TX · Clinical Psychologist in Texas

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 21, 2010. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
Order and Referring (CMS).
Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.