Provider Demographics
NPI:1275858326
Name:WALTERS, DAVID T (PCC)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:T
Last Name:WALTERS
Suffix:
Gender:M
Credentials:PCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24800 HIGHPOINT RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-6052
Mailing Address - Country:US
Mailing Address - Phone:216-831-6611
Mailing Address - Fax:216-831-2726
Practice Address - Street 1:25111 COUNTRY CLUB BLVD
Practice Address - Street 2:SUITE 290
Practice Address - City:NORTH OLMSTED
Practice Address - State:OH
Practice Address - Zip Code:44070-5345
Practice Address - Country:US
Practice Address - Phone:216-831-6611
Practice Address - Fax:216-831-2726
Is Sole Proprietor?:No
Enumeration Date:2010-04-01
Last Update Date:2010-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE0602193101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional