Provider Demographics
NPI:1831990936
Name:WALTERS, SHAWN RICHARD (AMFT#138642)
Entity type:Individual
Prefix:
First Name:SHAWN
Middle Name:RICHARD
Last Name:WALTERS
Suffix:
Gender:
Credentials:AMFT#138642
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:667 LYTTON AVE STE 9
Mailing Address - Street 2:
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94301-1335
Mailing Address - Country:US
Mailing Address - Phone:415-329-2882
Mailing Address - Fax:
Practice Address - Street 1:667 LYTTON AVE STE 9
Practice Address - Street 2:
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94301-1335
Practice Address - Country:US
Practice Address - Phone:415-329-2882
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-24
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1386421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical