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General NPI Number Information
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NPI Number | 1154076321
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Entity Type | Individual
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Provider Name | CHRISTINE WALTER MFT
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Gender | Female
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Dates
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Enumeration Date | 02/16/2022
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Last Update Date | 02/16/2022
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Provider Practice Location Address
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Address Line | 5379 LYONS RD # 3173
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City | COCONUT CREEK
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State | FL
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Zip | 33073-2810
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Country | US
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Telephone | 954-319-7010
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Fax |
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Provider Business Mailing Address
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Address Line | 941 NE 19TH AVE STE 206
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City | FORT LAUDERDALE
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State | FL
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Zip | 33304-3070
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Country | US
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Telephone | 954-319-7010
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | IMT3646
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License Number State | FL
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