Provider Demographics
NPI:1417306689
Name:WALDEN, MARY (MED)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:WALDEN
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 CLEVELAND AVE
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70458-3920
Mailing Address - Country:US
Mailing Address - Phone:985-643-5746
Mailing Address - Fax:
Practice Address - Street 1:150 CLEVELAND AVE
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70458-3920
Practice Address - Country:US
Practice Address - Phone:985-643-5746
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-08
Last Update Date:2016-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor