Provider Demographics
NPI:1023309085
Name:WALTERS, EBAN (PHD)
Entity type:Individual
Prefix:
First Name:EBAN
Middle Name:
Last Name:WALTERS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7608 WILLOW ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70118-4052
Mailing Address - Country:US
Mailing Address - Phone:504-302-3226
Mailing Address - Fax:
Practice Address - Street 1:4401 VETERANS MEMORIAL BLVD
Practice Address - Street 2:SUITE 201
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70006-5340
Practice Address - Country:US
Practice Address - Phone:504-302-3226
Practice Address - Fax:504-267-0298
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-26
Last Update Date:2013-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1150103TC2200X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical