Provider Demographics
NPI:1306593439
Name:WALTKE, STEFAN CHASE (LPC)
Entity type:Individual
Prefix:MR
First Name:STEFAN
Middle Name:CHASE
Last Name:WALTKE
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:MR
Other - First Name:STEFAN
Other - Middle Name:CHASE
Other - Last Name:ENTLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4425 PLANO PKWY STE 701
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75010-5031
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4425 PLANO PKWY STE 701
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75010-5031
Practice Address - Country:US
Practice Address - Phone:972-357-6387
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-08
Last Update Date:2022-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX83394101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional