Provider Demographics
NPI:1598737603
Name:WALTERS, GREGORY JAMES (MA, NCC, LPC)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:JAMES
Last Name:WALTERS
Suffix:
Gender:M
Credentials:MA, NCC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3721 EMMET DR
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16511-2004
Mailing Address - Country:US
Mailing Address - Phone:814-897-9844
Mailing Address - Fax:814-897-1262
Practice Address - Street 1:3721 EMMET DR
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16511-2004
Practice Address - Country:US
Practice Address - Phone:814-897-9844
Practice Address - Fax:814-897-1262
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC003647101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA410509OtherUPMC HEALTH PLAN
PA560217OtherVALUE OPTIONS