Basic Information
| Provider Information | |||||||||
| NPI: | 1043651607 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WALTHER | ||||||||
| FirstName: | JACQUELYN | ||||||||
| MiddleName: | ANN | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | MA, CI, NCC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3801 CANAL ST | ||||||||
| Address2: | SUITE 220 | ||||||||
| City: | NEW ORLEANS | ||||||||
| State: | LA | ||||||||
| PostalCode: | 701196082 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5044822735 | ||||||||
| FaxNumber: | 5044822737 | ||||||||
| Practice Location | |||||||||
| Address1: | 3801 CANAL ST | ||||||||
| Address2: | SUITE 220 | ||||||||
| City: | NEW ORLEANS | ||||||||
| State: | LA | ||||||||
| PostalCode: | 701196082 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5044822735 | ||||||||
| FaxNumber: | 5044822737 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/11/2013 | ||||||||
| LastUpdateDate: | 03/29/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.