Provider Demographics
NPI:1578590956
Name:WALTERS, JAMES KARL (PHD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:KARL
Last Name:WALTERS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:391 RABUCK DR
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17112-3168
Mailing Address - Country:US
Mailing Address - Phone:717-545-2726
Mailing Address - Fax:
Practice Address - Street 1:4715 VIEWRIDGE AVE
Practice Address - Street 2:SUITE 230
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-1658
Practice Address - Country:US
Practice Address - Phone:800-257-8715
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2011-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS004280L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA653737J99Medicare ID - Type Unspecified