Sally Ann Waller, PHD, LMHC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

LH00005716 Issued in WA

Practice address

17321 Evanston Ave N
Shoreline, WA 98133-5235

Phone

(206) 533-0776

Fax

(206) 533-0776

NPI assigned

Aug 9, 2006

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Philosophy

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1155081600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1508876582",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17321 EVANSTON AVE N",
            "city": "SHORELINE",
            "state": "WA",
            "postal_code": "981335235",
            "telephone_number": "206-533-0776",
            "fax_number": "206-533-0776"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17321 EVANSTON AVE N",
            "city": "SHORELINE",
            "state": "WA",
            "postal_code": "981335235",
            "telephone_number": "206-533-0776",
            "fax_number": "206-533-0776"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLER",
        "first_name": "SALLY",
        "middle_name": "ANN",
        "credential": "PHD, LMHC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-08-09",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "WA",
            "license": "LH00005716",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Walgreen Co (Walgreens #04759)
• Walgreens
• Sofia Wall
• John G Wallace, M.D.
• Kaitlin P Waller, LMHCA
• Linda Louise Walsh, MS LMHC
• Ronald Stewart Walton, DVM
• Johanna Wang, MD
• Wenbin Wang
• Latu Deressa Wanjalatan

• Mental Health Counselor in Shoreline, WA
• Providers in Shoreline, WA by specialty
• Mental Health Counselor in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.