Individual
THOMAS WALTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MS, LAC, LISAC
Contact information
Practice address
1901 N TREKELL RD, CASA GRANDE, AZ 85122-1770
(520) 421-3321
(520) 421-0087
Mailing address
2893 N ROSA AVE, CASA GRANDE, AZ 85122-5808
(520) 423-2121
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
LISAC-10457
AZ
101YM0800X
Mental Health Counselor
LAC-14414
AZ
Other
Enumeration date
10/10/2014
Last updated
10/10/2014
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