Provider Demographics
NPI:1851332464
Name:WALTON, KRISTOPHER LEON (LCSW)
Entity Type:Individual
Prefix:
First Name:KRISTOPHER
Middle Name:LEON
Last Name:WALTON
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3760 WASHINGTON PKWY
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83404-7593
Mailing Address - Country:US
Mailing Address - Phone:208-524-4953
Mailing Address - Fax:208-524-7335
Practice Address - Street 1:3760 WASHINGTON PKWY
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83404-7593
Practice Address - Country:US
Practice Address - Phone:208-524-4953
Practice Address - Fax:208-524-7335
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCSW-1311104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker