Provider Demographics
NPI:1649934506
Name:WALTON, DEMETRIUS (LMFT)
Entity type:Individual
Prefix:MR
First Name:DEMETRIUS
Middle Name:
Last Name:WALTON
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 N MAIN ST STE C
Mailing Address - Street 2:
Mailing Address - City:SALADO
Mailing Address - State:TX
Mailing Address - Zip Code:76571-2102
Mailing Address - Country:US
Mailing Address - Phone:254-410-3129
Mailing Address - Fax:
Practice Address - Street 1:7 N MAIN ST STE C
Practice Address - Street 2:
Practice Address - City:SALADO
Practice Address - State:TX
Practice Address - Zip Code:76571-2102
Practice Address - Country:US
Practice Address - Phone:254-410-3129
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-27
Last Update Date:2023-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX204275106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist