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General NPI Number Information
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NPI Number | 1669223640
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Entity Type | Individual
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Provider Name | BETHANY WALTERS
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Gender | Female
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Dates
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Enumeration Date | 03/28/2024
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Last Update Date | 10/16/2024
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Provider Practice Location Address
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Address Line | 22606 HAMLIN ST
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City | WEST HILLS
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State | CA
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Zip | 91307-3638
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Country | US
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Telephone | 407-620-1120
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Fax |
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Provider Business Mailing Address
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Address Line | 23055 SHERMAN WAY UNIT 4482
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City | WEST HILLS
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State | CA
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Zip | 91308-7029
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Country | US
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Telephone | 407-620-1120
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY34942
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License Number State | CA
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