Individual
ETHAN KYLE WALTZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMSW, LMT
Contact information
Practice address
282 VILLAGE LAKE CIR, SMYRNA, TN 37167-4317
(615) 613-1562
Mailing address
282 VILLAGE LAKE CIR, SMYRNA, TN 37167-4317
(615) 613-1562
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
014172
TN
Other
Enumeration date
05/24/2024
Last updated
05/24/2024
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