Provider Demographics
NPI:1093838757
Name:MANSFIELD, WALTER JAMES
Entity Type:Individual
Prefix:
First Name:WALTER
Middle Name:JAMES
Last Name:MANSFIELD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 431
Mailing Address - Street 2:
Mailing Address - City:DAVIS
Mailing Address - State:CA
Mailing Address - Zip Code:95617-0431
Mailing Address - Country:US
Mailing Address - Phone:530-753-1653
Mailing Address - Fax:
Practice Address - Street 1:24321 COUNTY RD. 96
Practice Address - Street 2:
Practice Address - City:DAVIS
Practice Address - State:CA
Practice Address - Zip Code:95616
Practice Address - Country:US
Practice Address - Phone:530-753-1653
Practice Address - Fax:530-753-7189
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2010-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health