Provider Demographics
NPI:1528109808
Name:WALTERS, CHAD TRAVIS
Entity type:Individual
Prefix:MR
First Name:CHAD
Middle Name:TRAVIS
Last Name:WALTERS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:402 MISSISSIPPI AVE
Mailing Address - Street 2:
Mailing Address - City:BOGALUSA
Mailing Address - State:LA
Mailing Address - Zip Code:70427-3852
Mailing Address - Country:US
Mailing Address - Phone:985-735-7280
Mailing Address - Fax:
Practice Address - Street 1:619 WILLIS AVE
Practice Address - Street 2:
Practice Address - City:BOGALUSA
Practice Address - State:LA
Practice Address - Zip Code:70427-3001
Practice Address - Country:US
Practice Address - Phone:985-732-6610
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health