Provider Demographics
NPI:1376639815
Name:MAJOR, WALTER (LPC)
Entity Type:Individual
Prefix:
First Name:WALTER
Middle Name:
Last Name:MAJOR
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1286 MATTHEWS LN
Mailing Address - Street 2:
Mailing Address - City:PARK HILLS
Mailing Address - State:MO
Mailing Address - Zip Code:63601-7207
Mailing Address - Country:US
Mailing Address - Phone:573-562-7751
Mailing Address - Fax:573-562-7843
Practice Address - Street 1:1286 MATTHEWS LN
Practice Address - Street 2:
Practice Address - City:PARK HILLS
Practice Address - State:MO
Practice Address - Zip Code:63601-7207
Practice Address - Country:US
Practice Address - Phone:573-562-7751
Practice Address - Fax:573-562-7843
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2016-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO200172571101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO495264228Medicaid