Provider Demographics
NPI:1972013522
Name:JACQUELYN A WALTHER, LPC, NCC
Entity Type:Organization
Organization Name:JACQUELYN A WALTHER, LPC, NCC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LPC
Authorized Official - Prefix:MRS
Authorized Official - First Name:JACQUELYN
Authorized Official - Middle Name:A
Authorized Official - Last Name:WALTHER
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:504-915-0147
Mailing Address - Street 1:5216 WILLOWTREE RD
Mailing Address - Street 2:
Mailing Address - City:MARRERO
Mailing Address - State:LA
Mailing Address - Zip Code:70072-4943
Mailing Address - Country:US
Mailing Address - Phone:504-915-0147
Mailing Address - Fax:
Practice Address - Street 1:3005 HARVARD AVE STE 201
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70006-6401
Practice Address - Country:US
Practice Address - Phone:504-915-0147
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-10
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty