Individual
WALTER DAVID REVOAL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.A, L.P.C
Contact information
Practice address
834 S SHERMAN ST, LONGMONT, CO 80501-6323
(303) 776-7840
(303) 776-7161
Mailing address
3757 STUART ST, DENVER, CO 80212-1921
(303) 455-3288
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
2103
CO
Other
Enumeration date
09/15/2006
Last updated
07/08/2007
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