Provider Demographics
NPI:1710748207
Name:CANDACE WALTERS AND ASSOCIATES
Entity Type:Organization
Organization Name:CANDACE WALTERS AND ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER/BILLING
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:L
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-210-7301
Mailing Address - Street 1:60117 HWY 203
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:OR
Mailing Address - Zip Code:97883-9521
Mailing Address - Country:US
Mailing Address - Phone:360-210-7301
Mailing Address - Fax:360-844-5184
Practice Address - Street 1:105 FIR ST.
Practice Address - Street 2:#327 SAC ANNEX BLDG.
Practice Address - City:LA GRANDE
Practice Address - State:OR
Practice Address - Zip Code:97850-2663
Practice Address - Country:US
Practice Address - Phone:541-246-3638
Practice Address - Fax:360-844-5184
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-22
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500708689Medicaid