MEDICARE: WALTERS COUNSELING, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	PC004264	PA

General Provider Information

NPI Number	:	1093118721
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WALTERS COUNSELING, LLC

Provider Business Mailing Address
First Line	:	PO BOX 74
Second Line	:
City	:	WYNCOTE
State	:	PA
Zip	:	19095-0074
Country	:	US
Telephone Number	:	215-990-4390
Fax Number	:

Provider Business Practice Location Address
First Line	:	1904 SOUTH ST
Second Line	:	FLOOR 3
City	:	PHILADELPHIA
State	:	PA
Zip	:	19146-1434
Country	:	US
Telephone Number	:	215-990-4390
Fax Number	:

Authorized Official
Title or Position	:	OWNER, LICENSED PROF. COUNSELOR
Name	:	JENNIFER WALTERS
Credential	:
Telephone Number	:	215-990-4390

Provider Enumeration Date	:	10/08/2014
Last Update Date	:	07/23/2015

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