Provider Demographics
NPI:1427266337
Name:WALTERS, JOHN F (MS, MDIV)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:F
Last Name:WALTERS
Suffix:
Gender:M
Credentials:MS, MDIV
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RR 1 BOX 75
Mailing Address - Street 2:
Mailing Address - City:NEW ALBANY
Mailing Address - State:PA
Mailing Address - Zip Code:18833-9730
Mailing Address - Country:US
Mailing Address - Phone:570-363-2808
Mailing Address - Fax:570-363-2648
Practice Address - Street 1:RR 1 BOX 75
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:PA
Practice Address - Zip Code:18833-9730
Practice Address - Country:US
Practice Address - Phone:570-363-2808
Practice Address - Fax:570-363-2648
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000821101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral