Healthcare Provider Details

I. General information

NPI: 1376639815
Provider Name (Legal Business Name): WALTER MAJOR LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 12/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1286 MATTHEWS LN
PARK HILLS MO
63601-7207
US

IV. Provider business mailing address

1286 MATTHEWS LN
PARK HILLS MO
63601-7207
US

V. Phone/Fax

Practice location:
  • Phone: 573-562-7751
  • Fax: 573-562-7843
Mailing address:
  • Phone: 573-562-7751
  • Fax: 573-562-7843

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number200172571
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: