Provider Demographics
NPI:1205992542
Name:TEACHOUT, WALTER FLOYD (PHD)
Entity type:Individual
Prefix:DR
First Name:WALTER
Middle Name:FLOYD
Last Name:TEACHOUT
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3902 N 31ST ST
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98407-5402
Mailing Address - Country:US
Mailing Address - Phone:253-761-8601
Mailing Address - Fax:253-761-8748
Practice Address - Street 1:3902 N 31ST ST
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98407-5402
Practice Address - Country:US
Practice Address - Phone:253-761-8601
Practice Address - Fax:253-761-8748
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA2091103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist