Provider Demographics
NPI:1982727954
Name:WALTER, TRUDY P (MA LPC)
Entity Type:Individual
Prefix:MS
First Name:TRUDY
Middle Name:P
Last Name:WALTER
Suffix:
Gender:F
Credentials:MA LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1660 OAK AVE
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80304-1257
Mailing Address - Country:US
Mailing Address - Phone:303-447-2392
Mailing Address - Fax:303-447-2392
Practice Address - Street 1:1660 OAK AVE
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80304-1257
Practice Address - Country:US
Practice Address - Phone:303-447-2392
Practice Address - Fax:303-447-2392
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2917103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO2917OtherLPC