Provider Demographics
NPI:1386215317
Name:GHANT, WALTER ALLEN (MA, LCMHA)
Entity Type:Individual
Prefix:MR
First Name:WALTER
Middle Name:ALLEN
Last Name:GHANT
Suffix:
Gender:M
Credentials:MA, LCMHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 BROADWAY ST STE 230
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98660-3320
Mailing Address - Country:US
Mailing Address - Phone:360-798-4682
Mailing Address - Fax:
Practice Address - Street 1:1101 BROADWAY ST STE 230
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98660-3320
Practice Address - Country:US
Practice Address - Phone:360-798-4682
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-09
Last Update Date:2021-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61176854101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health