Provider Demographics
NPI:1275856981
Name:WALTERS, TAMU A (CAC)
Entity Type:Individual
Prefix:MS
First Name:TAMU
Middle Name:A
Last Name:WALTERS
Suffix:
Gender:F
Credentials:CAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19404 N 10TH ST
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433-8892
Mailing Address - Country:US
Mailing Address - Phone:985-871-1380
Mailing Address - Fax:985-871-1387
Practice Address - Street 1:19404 N 10TH ST
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-8892
Practice Address - Country:US
Practice Address - Phone:985-871-1380
Practice Address - Fax:985-871-1387
Is Sole Proprietor?:No
Enumeration Date:2010-03-09
Last Update Date:2010-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1287101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)