Provider Demographics
NPI:1194842047
Name:WALTER, THOMAS MCQUADE (LPC)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:MCQUADE
Last Name:WALTER
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 CHAPMAN CIR
Mailing Address - Street 2:
Mailing Address - City:WAXAHACHIE
Mailing Address - State:TX
Mailing Address - Zip Code:75165-1917
Mailing Address - Country:US
Mailing Address - Phone:972-351-1113
Mailing Address - Fax:
Practice Address - Street 1:206 S ROGERS ST
Practice Address - Street 2:SUITE 207
Practice Address - City:WAXAHACHIE
Practice Address - State:TX
Practice Address - Zip Code:75165-3683
Practice Address - Country:US
Practice Address - Phone:972-351-4141
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17133101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional