Organization
TERRY WALTERS PH D PC
Active
Organization
TERRY WALTERS PH D PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TERRY LYNNE WALTERS PH.D. (PRESIDENT)
(817) 485-9003
Entity
Organization
Contact information
Practice address
517 HARWOOD RD, STE 102, BEDFORD, TX 76021-4109
(817) 485-9003
Mailing address
517 HARWOOD RD, STE 102, BEDFORD, TX 76021-4109
(817) 485-9003
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00G63C
MEDICARE ID
TX
01
—
G63C
BCBS PROVIDER NUMBER
TX
Enumeration date
04/18/2012
Last updated
04/18/2012
Update your record
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