MEDICARE: ENEZIAH WALTERS LCSW LLC

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
1	104100000X	Social Worker

General Provider Information

NPI Number	:	1952030587
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ENEZIAH WALTERS LCSW LLC

Provider Business Mailing Address
First Line	:	134 W MAPLE ST
Second Line	:
City	:	MASON
State	:	MI
Zip	:	48854-1657
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	616 S CREYTS RD STE D
Second Line	:
City	:	LANSING
State	:	MI
Zip	:	48917-8269
Country	:	US
Telephone Number	:	517-512-5289
Fax Number	:

Authorized Official
Title or Position	:	CREDENTIALING
Name	:	MARY BETH HOUPT
Credential	:
Telephone Number	:	517-676-9797

Provider Enumeration Date	:	06/08/2022
Last Update Date	:	06/02/2026

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