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General NPI Number Information
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NPI Number | 1801002431
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Entity Type | Organization
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Legal Business Name | WALTON BRUESKE COUNSELING GROUP PA
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Dates
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Enumeration Date | 05/14/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3810-1 WILLIAMSBURG PARK BLVD
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City | JACKSONVILLE
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State | FL
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Zip | 32257-9217
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Country | US
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Telephone | 904-733-9669
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Fax | 904-733-4194
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Provider Business Mailing Address
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Address Line | 3810-1 WILLIAMSBURG PARK BLVD
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City | JACKSONVILLE
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State | FL
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Zip | 32257-9217
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Country | US
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Telephone | 904-733-9669
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Fax | 904-733-4194
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ROBERT SCOTT WALTON
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Credential | PHD
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Telephone | 904-733-9669
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MH209
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MH2109
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License Number State | FL
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