Provider Demographics
NPI:1023300035
Name:WALTON, ROBERT LEE III (MA, LPC)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:LEE
Last Name:WALTON
Suffix:III
Gender:M
Credentials:MA, LPC
Other - Prefix:
Other - First Name:LEE
Other - Middle Name:
Other - Last Name:WALTON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA, LPC
Mailing Address - Street 1:14642 S HIGHWAY 170
Mailing Address - Street 2:
Mailing Address - City:WEST FORK
Mailing Address - State:AR
Mailing Address - Zip Code:72774-9224
Mailing Address - Country:US
Mailing Address - Phone:720-217-7596
Mailing Address - Fax:
Practice Address - Street 1:1 W SUNBRIDGE DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-1825
Practice Address - Country:US
Practice Address - Phone:720-217-7596
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-09
Last Update Date:2018-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO11203101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional