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

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

2009035484 Issued in MO

Practice address

12400 Olive Blvd
Suite 205
Saint Louis, MO 63141-5454

Phone

(314) 607-2801

NPI assigned

Dec 10, 2009

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

State licenses

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

{
    "created_epoch": "1260403200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1260403200000",
    "number": "1639408214",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13211 WINDYGATE LN",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631462227",
            "telephone_number": "314-607-2801"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12400 OLIVE BLVD",
            "address_2": "SUITE 205",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631415454",
            "telephone_number": "314-607-2801"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALL",
        "first_name": "DEREK",
        "middle_name": "JUSTIN",
        "credential": "M.S., LPC, NCC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2009-12-10",
        "last_updated": "2009-12-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "MO",
            "license": "2009035484",
            "primary": true
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "IL",
            "license": "180.007223",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ted Walker, M.D.
• Virginia Walker
• Yuri Nicholas Walker, RN, JD
• Walking Each Other Home Wellness LLC
• Courtney Paige Wall, PMHNP-BC
• Kirk Wall
• Kristin Leigh Wall, WHNP
• Leonard Lewis Wall, MD
• Megan Wall, DPT
• Tyler James Wall, MD

• Professional Counselor in Saint Louis, MO
• Providers in Saint Louis, MO by specialty
• Professional Counselor in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 10, 2009; 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.