Doctor Name: | WALTER DAVID REVOAL |
NPI Number: | 1932205143 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | M.A, L.P.C |
License Number: | 2103 |
Business Practice Address: | 834 S Sherman St Longmont, CO - 805016323 |
Business Phone Number: | 3037767840 |
Business Fax Number: | 3037767161 |
Mailing Address: | 3757 Stuart St, DENVER |
State: | CO |
Postal Code: | 802121921 |
Phone Number: | 3034553288 |
Fax Number: | |
NPI Enumeration Date: | 09/15/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101Y00000X |
License Number: | 2103 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CO |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | |
Taxonomy Definition: | A provider who is trained and educated in the performance of behavior health services through interpersonal communications and analysis. Training and education at the specialty level usually requires a master |