Doctor Name: | MR. CRAIG ALLEN WALSETH |
NPI Number: | 1003820085 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | LPC |
License Number: | 2005028660 |
Business Practice Address: | 1480 Woodstone Dr Suite211 Saint Charles, MO - 633046869 |
Business Phone Number: | 6364470100 |
Business Fax Number: | 6364470100 |
Mailing Address: | 1480 Woodstone Dr, Suite211 SAINT CHARLES |
State: | MO |
Postal Code: | 633046869 |
Phone Number: | 6364470100 |
Fax Number: | 6364470100 |
NPI Enumeration Date: | 07/28/2006 |
NPI Last Update Date: | 01/04/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | 2005028660 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MO |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |