Provider Demographics
NPI:1437419967
Name:WALTER, COLETTE ROSHONE (BHRS)
Entity Type:Individual
Prefix:
First Name:COLETTE
Middle Name:ROSHONE
Last Name:WALTER
Suffix:
Gender:F
Credentials:BHRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1805 NE 52ND ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73111-7007
Mailing Address - Country:US
Mailing Address - Phone:405-589-4906
Mailing Address - Fax:
Practice Address - Street 1:1805 NE 52ND ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73111-7007
Practice Address - Country:US
Practice Address - Phone:405-589-4906
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-17
Last Update Date:2012-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst