Provider Demographics
NPI:1124367461
Name:WALTER, PATRICIA SUE (MFT, BC-ATR)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:SUE
Last Name:WALTER
Suffix:
Gender:F
Credentials:MFT, BC-ATR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2021 BALMER DR
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90039-3001
Mailing Address - Country:US
Mailing Address - Phone:818-990-5499
Mailing Address - Fax:
Practice Address - Street 1:13701 RIVERSIDE DR STE 302
Practice Address - Street 2:
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91423-2447
Practice Address - Country:US
Practice Address - Phone:818-990-5499
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-06
Last Update Date:2013-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC15010106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist