Provider Demographics
NPI:1821225814
Name:JOANN F. WALTERS
Entity Type:Organization
Organization Name:JOANN F. WALTERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:LAZARE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-633-2000
Mailing Address - Street 1:4550 E BELL RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-9306
Mailing Address - Country:US
Mailing Address - Phone:602-633-2000
Mailing Address - Fax:602-633-6225
Practice Address - Street 1:4550 E BELL RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-9306
Practice Address - Country:US
Practice Address - Phone:602-633-2000
Practice Address - Fax:602-633-6225
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COMPASS MENTAL HEALTH LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-06-17
Last Update Date:2009-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBH3143251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health