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NPI Code Detail

MEDICARE: MS. AMANDA L WALTON LMHC

MEDICARE: MS. AMANDA L WALTON LMHC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health CounselorMH 11323FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MH 11323OTHERFLLICENSED MENTAL HEALTH COUNSELOR

General Provider Information

NPI Number : 1407104003
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. AMANDA L WALTON LMHC
Provider Business Mailing Address
First Line : 3686 US HIGHWAY 331 SOUTH
Second Line :
City : DEFUNIAK SPRINGS
State : FL
Zip : 32435-8463
Country : US
Telephone Number : 850-892-8035
Fax Number : 850-892-8074
Provider Business Practice Location Address
First Line : 3686 US HIGHWAY 331 SOUTH
Second Line :
City : DEFUNIAK SPRINGS
State : FL
Zip : 32435-8463
Country : US
Telephone Number : 850-892-8035
Fax Number : 850-892-8074
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/29/2012
Last Update Date : 09/04/2012

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