Provider Demographics
NPI:1598212680
Name:WALTERS, MICHELLE S (LICENSED MFT)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:S
Last Name:WALTERS
Suffix:
Gender:F
Credentials:LICENSED MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:184 ARBUSTO CIR
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95831-4560
Mailing Address - Country:US
Mailing Address - Phone:480-603-7499
Mailing Address - Fax:
Practice Address - Street 1:265 NEVADA ST
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:CA
Practice Address - Zip Code:95603-4617
Practice Address - Country:US
Practice Address - Phone:480-603-7499
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-06
Last Update Date:2020-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA118364106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist