Provider Demographics
NPI:1477799930
Name:WALTON, BETH ANNE (MFT)
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:ANNE
Last Name:WALTON
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:346 LAKEVIEW WAY
Mailing Address - Street 2:
Mailing Address - City:EMERALD HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:94062-3317
Mailing Address - Country:US
Mailing Address - Phone:650-208-3078
Mailing Address - Fax:
Practice Address - Street 1:346 LAKEVIEW WAY
Practice Address - Street 2:
Practice Address - City:EMERALD HILLS
Practice Address - State:CA
Practice Address - Zip Code:94062-3317
Practice Address - Country:US
Practice Address - Phone:650-208-3078
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-05
Last Update Date:2009-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC33467106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist