Provider Demographics
NPI:1912921099
Name:PINTAL, WALTER J (PSYD)
Entity Type:Individual
Prefix:DR
First Name:WALTER
Middle Name:J
Last Name:PINTAL
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:630 N COIT RD
Mailing Address - Street 2:SUITE 2200
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080-3700
Mailing Address - Country:US
Mailing Address - Phone:214-389-7351
Mailing Address - Fax:214-389-7435
Practice Address - Street 1:630 N COIT RD
Practice Address - Street 2:SUITE 2200
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-3700
Practice Address - Country:US
Practice Address - Phone:214-389-7351
Practice Address - Fax:214-389-7435
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2016-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20040706A103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX32448OtherLICENSED PSYCHOLOGIST
TX164746304Medicaid
NC1831OtherLICENSED PSYCHOLOGIST
IN20040706OtherLICENSED PSYCHOLOGIST
TX612090Medicare ID - Type UnspecifiedINDIVIDUAL PROVIDER NUMBE