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General NPI Number Information
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NPI Number | 1982040135
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Entity Type | Organization
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Legal Business Name | KRISTOPHER L. WALTON & ASSOCIATES, LLC
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Dates
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Enumeration Date | 05/15/2013
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Last Update Date | 05/15/2013
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Provider Practice Location Address
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Address Line | 2265 TETON PLZ
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City | IDAHO FALLS
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State | ID
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Zip | 83404-6486
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Country | US
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Telephone | 208-403-0135
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Fax |
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Provider Business Mailing Address
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Address Line | 2265 TETON PLZ
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City | IDAHO FALLS
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State | ID
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Zip | 83404-6486
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Country | US
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Telephone | 208-403-0135
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Fax |
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | MR. KRISTOPHER LEON WALTON
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Credential |
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Telephone | 208-403-0135
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LCSW 1311
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License Number State | ID
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