Basic Information
| Provider Information | |||||||||
| NPI: | 1639236474 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WALTON | ||||||||
| FirstName: | MARIA | ||||||||
| MiddleName: | FAYE | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LCSW | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | VAUGHT | ||||||||
| OtherFirstName: | MARIA | ||||||||
| OtherMiddleName: | FAYE | ||||||||
| OtherNamePrefix: | MRS. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | LCSW; PHD | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1720 W END AVE | ||||||||
| Address2: | SUITE 240 | ||||||||
| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 372032612 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6153201155 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1720 W END AVE | ||||||||
| Address2: | SUITE 240 | ||||||||
| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 372032612 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6153201155 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/02/2007 | ||||||||
| LastUpdateDate: | 09/22/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 3887 | TN | N | Behavioral Health & Social Service Providers | Social Worker | Clinical | 103T00000X | 3244 | TN | Y | Behavioral Health & Social Service Providers | Psychologist |
No ID Information.