Provider Demographics
NPI:1205995313
Name:WALTERS, JUDY J (MS LMFT)
Entity type:Individual
Prefix:MS
First Name:JUDY
Middle Name:J
Last Name:WALTERS
Suffix:
Gender:F
Credentials:MS LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1015 MESOPOTAMIA ST
Mailing Address - Street 2:
Mailing Address - City:EUTAW
Mailing Address - State:AL
Mailing Address - Zip Code:35462-1041
Mailing Address - Country:US
Mailing Address - Phone:205-372-3840
Mailing Address - Fax:
Practice Address - Street 1:1215 S WALNUT AVE
Practice Address - Street 2:
Practice Address - City:DEMOPOLIS
Practice Address - State:AL
Practice Address - Zip Code:36732-3615
Practice Address - Country:US
Practice Address - Phone:334-289-2410
Practice Address - Fax:334-289-2416
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL85106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist