Provider Demographics
NPI:1285051078
Name:HOWARD, WALTER (MS, LMFT)
Entity type:Individual
Prefix:
First Name:WALTER
Middle Name:
Last Name:HOWARD
Suffix:
Gender:M
Credentials:MS, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5010 SW 19TH ST
Mailing Address - Street 2:
Mailing Address - City:WEST PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33023-3271
Mailing Address - Country:US
Mailing Address - Phone:954-256-4601
Mailing Address - Fax:
Practice Address - Street 1:7481 W OAKLAND PARK BLVD
Practice Address - Street 2:SUITE 302 C
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33319-4985
Practice Address - Country:US
Practice Address - Phone:954-256-4601
Practice Address - Fax:954-491-4255
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-18
Last Update Date:2015-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT 2758101Y00000X, 101YM0800X, 101YP2500X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL013424400Medicaid