Provider Demographics
NPI:1407993652
Name:WALTER, WADE JAMES (MA)
Entity Type:Individual
Prefix:MR
First Name:WADE
Middle Name:JAMES
Last Name:WALTER
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9515 82ND AVE NW
Mailing Address - Street 2:
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98332-6710
Mailing Address - Country:US
Mailing Address - Phone:360-473-3172
Mailing Address - Fax:
Practice Address - Street 1:3580 PACIFIC AVE
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98418-7915
Practice Address - Country:US
Practice Address - Phone:253-798-4373
Practice Address - Fax:253-798-2721
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00007547101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health