Provider Demographics
NPI:1447474564
Name:WALL, BRENDA B (PHD)
Entity type:Individual
Prefix:DR
First Name:BRENDA
Middle Name:B
Last Name:WALL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12012 WICKCHESTER LN
Mailing Address - Street 2:SUITE 550
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77079-1229
Mailing Address - Country:US
Mailing Address - Phone:832-448-2830
Mailing Address - Fax:832-448-2801
Practice Address - Street 1:4610 CLAY COURT LN
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76017-1618
Practice Address - Country:US
Practice Address - Phone:469-767-9908
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2010-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX22619103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical