Provider Demographics
NPI:1841760675
Name:WALTER, JOSHUA P (LAC)
Entity Type:Individual
Prefix:MR
First Name:JOSHUA
Middle Name:P
Last Name:WALTER
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 N FRONT ST
Mailing Address - Street 2:
Mailing Address - City:DARDANELLE
Mailing Address - State:AR
Mailing Address - Zip Code:72834-3821
Mailing Address - Country:US
Mailing Address - Phone:479-477-3058
Mailing Address - Fax:
Practice Address - Street 1:105 N FRONT ST
Practice Address - Street 2:
Practice Address - City:DARDANELLE
Practice Address - State:AR
Practice Address - Zip Code:72834-3821
Practice Address - Country:US
Practice Address - Phone:479-477-3058
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-05
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARP2307001101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor