Provider Demographics
NPI:1699019836
Name:WALSTON, ARLENE MARIE
Entity Type:Individual
Prefix:MRS
First Name:ARLENE
Middle Name:MARIE
Last Name:WALSTON
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:ARLENE
Other - Middle Name:MARIE
Other - Last Name:WALSTON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MFT TRAINEE
Mailing Address - Street 1:1605 CHARTERTEN AVE
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93307-5967
Mailing Address - Country:US
Mailing Address - Phone:661-428-7317
Mailing Address - Fax:
Practice Address - Street 1:730 21ST ST
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93301-2913
Practice Address - Country:US
Practice Address - Phone:661-829-5930
Practice Address - Fax:661-427-0386
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-10
Last Update Date:2012-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32-0285844106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA32-0285844OtherMEDI CAL