Healthcare Provider Details

I. General information

NPI: 1508437708
Provider Name (Legal Business Name): MICHAEL STEPHEN WALTERS LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2021
Last Update Date: 07/08/2021
Certification Date: 06/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MICHAEL WALTERS 13870 HERITAGE
RIVERVIEW MI
48193
US

IV. Provider business mailing address

MICHAEL WALTERS 13870 HERITAGE
RIVERVIEW MI
48193
US

V. Phone/Fax

Practice location:
  • Phone: 734-934-0431
  • Fax:
Mailing address:
  • Phone: 734-934-0431
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401007264
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: