Provider Demographics
NPI:1154901171
Name:GANTT, WALTER BRANDON (LPC, CSAT)
Entity type:Individual
Prefix:MR
First Name:WALTER
Middle Name:BRANDON
Last Name:GANTT
Suffix:
Gender:M
Credentials:LPC, CSAT
Other - Prefix:MR
Other - First Name:BRANDON
Other - Middle Name:KNIGHT
Other - Last Name:GANTT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC, CSAT
Mailing Address - Street 1:8396 TIMBER CREEK DR
Mailing Address - Street 2:
Mailing Address - City:PIKE ROAD
Mailing Address - State:AL
Mailing Address - Zip Code:36064-2276
Mailing Address - Country:US
Mailing Address - Phone:407-739-1979
Mailing Address - Fax:
Practice Address - Street 1:8650 MINNIE BROWN RD
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36117-7803
Practice Address - Country:US
Practice Address - Phone:334-324-6588
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-13
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALLPC05194101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health