Healthcare Provider Details

I. General information

NPI: 1518237841
Provider Name (Legal Business Name): JOSIE MARY WALTON M.A., LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/03/2012
Last Update Date: 01/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7728 JAVELINA RD SW
ALBUQUERQUE NM
87121-5318
US

IV. Provider business mailing address

7728 JAVELINA RD SW
ALBUQUERQUE NM
87121-5318
US

V. Phone/Fax

Practice location:
  • Phone: 505-263-8667
  • Fax: 505-839-9459
Mailing address:
  • Phone: 505-263-8667
  • Fax: 505-839-9459

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0139701
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: