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General NPI Number Information
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NPI Number | 1376789198
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Entity Type | Individual
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Provider Name | DIANA YVONNE WALTER M.S., LPC, LMFT
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Gender | Female
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Dates
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Enumeration Date | 12/29/2008
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Last Update Date | 11/19/2015
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Provider Practice Location Address
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Address Line | 4125 S. HWY 89 PUB PLACE CENTER, OFFICE 4
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City | JACKSON
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State | WY
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Zip | 83001
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Country | US
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Telephone | 307-739-0888
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Fax | 307-733-8351
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Provider Business Mailing Address
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Address Line | 8350 S HENRYS RD
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City | JACKSON
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State | WY
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Zip | 83001
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Country | US
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Telephone | 307-739-0888
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Fax | 307-733-8351
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LPC-505
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License Number State | WY
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | LMFT-072
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License Number State | WY
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