Provider Demographics
NPI:1508437708
Name:WALTERS, MICHAEL STEPHEN (LPC)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:STEPHEN
Last Name:WALTERS
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:MICHAEL WALTERS
Mailing Address - Street 2:13870 HERITAGE
Mailing Address - City:RIVERVIEW
Mailing Address - State:MI
Mailing Address - Zip Code:48193
Mailing Address - Country:US
Mailing Address - Phone:734-934-0431
Mailing Address - Fax:
Practice Address - Street 1:MICHAEL WALTERS
Practice Address - Street 2:13870 HERITAGE
Practice Address - City:RIVERVIEW
Practice Address - State:MI
Practice Address - Zip Code:48193
Practice Address - Country:US
Practice Address - Phone:734-934-0431
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-08
Last Update Date:2021-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401007264101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty