Provider Demographics
NPI:1205974664
Name:WALTERS, MARSHELL SUNNATTA (IMF)
Entity type:Individual
Prefix:
First Name:MARSHELL
Middle Name:SUNNATTA
Last Name:WALTERS
Suffix:
Gender:F
Credentials:IMF
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3125 W DURANGO ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85009-6217
Mailing Address - Country:US
Mailing Address - Phone:602-372-7226
Mailing Address - Fax:
Practice Address - Street 1:3125 W DURANGO ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85009-6217
Practice Address - Country:US
Practice Address - Phone:602-372-7226
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2008-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF 52514101YM0800X, 1041C0700X
AZ101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical