Healthcare Provider Details

I. General information

NPI: 1487520912
Provider Name (Legal Business Name): CHRISLEIGH NICOLE WALTON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2025
Last Update Date: 10/21/2025
Certification Date: 10/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4749 ODOM RD
BEAUMONT TX
77706-7080
US

IV. Provider business mailing address

4749 ODOM RD
BEAUMONT TX
77706-7080
US

V. Phone/Fax

Practice location:
  • Phone: 409-200-2220
  • Fax:
Mailing address:
  • Phone: 409-200-2220
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number100490
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: