Provider Demographics
NPI:1710192893
Name:LAFRENIERE, WALTER RICHARD (LPC)
Entity Type:Individual
Prefix:MR
First Name:WALTER
Middle Name:RICHARD
Last Name:LAFRENIERE
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 8TH AVE
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-4115
Mailing Address - Country:US
Mailing Address - Phone:817-923-2544
Mailing Address - Fax:
Practice Address - Street 1:1601 8TH AVE
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-4115
Practice Address - Country:US
Practice Address - Phone:817-923-2544
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-11
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX03676101YP2500X
TX002359106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist