Provider Demographics
NPI:1649408006
Name:COLLINS-WALTERS, JO ANN (LPC, LISAC, CCTP)
Entity Type:Individual
Prefix:MISS
First Name:JO
Middle Name:ANN
Last Name:COLLINS-WALTERS
Suffix:
Gender:F
Credentials:LPC, LISAC, CCTP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4447 E BROADWAY RD STE 106
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-2018
Mailing Address - Country:US
Mailing Address - Phone:480-964-3914
Mailing Address - Fax:480-300-4128
Practice Address - Street 1:4447 E BROADWAY RD STE 106
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-2018
Practice Address - Country:US
Practice Address - Phone:480-964-3914
Practice Address - Fax:480-300-4128
Is Sole Proprietor?:No
Enumeration Date:2009-06-24
Last Update Date:2020-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLISAC-15061101YA0400X
AZLPC-16575101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)