Individual
JASON MICHAEL WALTER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LPCC, LADC
Contact information
Practice address
8530 EAGLE POINT BLVD STE 100, LAKE ELMO, MN 55042-8648
(612) 562-6766
(612) 638-6601
Mailing address
6656 PINE CREST TRL S, COTTAGE GROVE, MN 55016-4679
(612) 562-6766
(612) 638-6601
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
304589
MN
101YM0800X
Mental Health Counselor
Primary
01898
MN
Other
Enumeration date
09/20/2016
Last updated
11/30/2018
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