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General NPI Number Information
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NPI Number | 1649934506
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Entity Type | Individual
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Provider Name | DEMETRIUS WALTON LMFT
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Gender | Male
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Dates
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Enumeration Date | 10/27/2021
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Last Update Date | 09/22/2023
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Provider Practice Location Address
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Address Line | 7 N MAIN ST STE C
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City | SALADO
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State | TX
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Zip | 76571-2102
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Country | US
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Telephone | 254-410-3129
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Fax |
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Provider Business Mailing Address
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Address Line | 7 N MAIN ST STE C
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City | SALADO
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State | TX
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Zip | 76571-2102
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Country | US
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Telephone | 254-410-3129
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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 | 204275
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License Number State | TX
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