Healthcare Provider Details

I. General information

NPI: 1053622316
Provider Name (Legal Business Name): MISS APRYL DAWN WALTERS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/01/2010
Last Update Date: 07/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 E CENTER ST
ANAHEIM CA
92805-3457
US

IV. Provider business mailing address

2710 ASSOCIATED RD APARTMENT #C68
FULLERTON CA
92835-2913
US

V. Phone/Fax

Practice location:
  • Phone: 714-780-0750
  • Fax: 714-780-0757
Mailing address:
  • Phone: 909-519-8291
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: