Provider Demographics
NPI:1295292217
Name:WALTERS, COLBY J (LPC)
Entity type:Individual
Prefix:DR
First Name:COLBY
Middle Name:J
Last Name:WALTERS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3306 CUMBERLAND AVE
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76707-1225
Mailing Address - Country:US
Mailing Address - Phone:972-935-8942
Mailing Address - Fax:
Practice Address - Street 1:3306 CUMBERLAND AVE
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76707-1225
Practice Address - Country:US
Practice Address - Phone:972-935-8942
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-26
Last Update Date:2019-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX71603101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional