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Organization
PHYLLIS WALTERS, PH.D.
Active
Organization
PHYLLIS WALTERS, PH.D.
Active
Other names
Phyllis Walters, Ph.D.
Organization subpart
No
Provider details
NPI number
Authorized official
MARCO BIANCHI (BILLING MANAGER)
(239) 297-1508
Entity
Organization
Contact information
Practice address
9220 BONITA BEACH RD SE STE 222, BONITA SPRINGS, FL 34135-4235
(239) 404-9396
Mailing address
9248 CYPRESS DR N, FORT MYERS, FL 33967-5440
(239) 297-1508
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
261QM0850X
Adult Mental Health Clinic/Center
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
Other
Enumeration date
01/07/2021
Last updated
01/07/2021
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