Provider Demographics
NPI:1508260290
Name:WALTON, HORACE GLEN (MED, LMSW-IPR)
Entity Type:Individual
Prefix:
First Name:HORACE
Middle Name:GLEN
Last Name:WALTON
Suffix:
Gender:M
Credentials:MED, LMSW-IPR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 549
Mailing Address - Street 2:
Mailing Address - City:GOLDTHWAITE
Mailing Address - State:TX
Mailing Address - Zip Code:76844-0549
Mailing Address - Country:US
Mailing Address - Phone:325-938-5518
Mailing Address - Fax:
Practice Address - Street 1:850 FM 574 W
Practice Address - Street 2:
Practice Address - City:GOLDTHWAITE
Practice Address - State:TX
Practice Address - Zip Code:76844-3379
Practice Address - Country:US
Practice Address - Phone:325-938-5518
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-09
Last Update Date:2014-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11285104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker