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General NPI Number Information
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NPI Number | 1851089635
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Entity Type | Organization
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Legal Business Name | WALTON SERVICES LLC
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Dates
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Enumeration Date | 04/28/2023
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Last Update Date | 04/28/2023
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Provider Practice Location Address
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Address Line | 3825 GILBERT DR STE 106
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City | SHREVEPORT
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State | LA
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Zip | 71104-5000
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Country | US
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Telephone | 318-301-3317
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 3757
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City | SHREVEPORT
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State | LA
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Zip | 71133-3757
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ANQUITRA WALTON
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Credential | LPC
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Telephone | 318-301-6617
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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 |
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License Number State |
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