Provider Demographics
NPI:1740031996
Name:WALTER, VIVIAN (COUNSELOR)
Entity type:Individual
Prefix:
First Name:VIVIAN
Middle Name:
Last Name:WALTER
Suffix:
Gender:F
Credentials:COUNSELOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 NW HARRISON BLVD
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97330-6277
Mailing Address - Country:US
Mailing Address - Phone:541-203-0485
Mailing Address - Fax:541-833-6656
Practice Address - Street 1:1300 NW HARRISON BLVD
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330-6277
Practice Address - Country:US
Practice Address - Phone:514-203-0485
Practice Address - Fax:541-833-6656
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-27
Last Update Date:2025-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health