Provider Demographics
NPI:1104256312
Name:DISNEY, WALTER DAVID (MFT)
Entity type:Individual
Prefix:
First Name:WALTER
Middle Name:DAVID
Last Name:DISNEY
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8100 MARTY ST STE 105
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66204-3737
Mailing Address - Country:US
Mailing Address - Phone:913-963-7772
Mailing Address - Fax:
Practice Address - Street 1:8100 MARTY ST STE 105
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66204-3737
Practice Address - Country:US
Practice Address - Phone:913-963-7772
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-25
Last Update Date:2013-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KST-LMFT 2504106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist