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Individual

BRANDON THOMAS WALTERS

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
LPC

Contact information

Practice address
1919 E THOMAS RD, PHOENIX, AZ 85016-7710
(602) 933-0990
(602) 933-4251
Mailing address
2108 E THOMAS RD STE 130, PHOENIX, AZ 85016-0008
(602) 933-3124

Taxonomy

Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
80828
TX
101YP2500X
Professional Counselor
Primary
LPC-22529
AZ

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
213280
AZ
Enumeration date
06/07/2022
Last updated
01/16/2024
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