Provider Demographics
NPI:1609973254
Name:WALTZ, TRISH I (LCSW)
Entity Type:Individual
Prefix:
First Name:TRISH
Middle Name:I
Last Name:WALTZ
Suffix:
Gender:F
Credentials:LCSW
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 1060
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:AR
Mailing Address - Zip Code:72650-1060
Mailing Address - Country:US
Mailing Address - Phone:870-448-5733
Mailing Address - Fax:870-448-3767
Practice Address - Street 1:2263 HWY 65 NORTH
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:AR
Practice Address - Zip Code:72650-1060
Practice Address - Country:US
Practice Address - Phone:870-448-5733
Practice Address - Fax:870-448-3392
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-17
Last Update Date:2023-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR7474-C104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker