Provider Demographics
NPI:1639301534
Name:WALTON, DOW EDWIN
Entity Type:Individual
Prefix:MR
First Name:DOW
Middle Name:EDWIN
Last Name:WALTON
Suffix:
Gender:M
Credentials:
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 224
Mailing Address - Street 2:
Mailing Address - City:CLEARLAKE OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:95423-0224
Mailing Address - Country:US
Mailing Address - Phone:707-998-9250
Mailing Address - Fax:707-350-5921
Practice Address - Street 1:7000#B SOUTH CENTER DRIVE
Practice Address - Street 2:
Practice Address - City:CLEARLAKE
Practice Address - State:CA
Practice Address - Zip Code:95422-8106
Practice Address - Country:US
Practice Address - Phone:707-994-7090
Practice Address - Fax:707-994-7092
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-11
Last Update Date:2010-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health