Provider Demographics
NPI:1023356128
Name:WALTHALL, KAREN (LPC)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:WALTHALL
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8930 FOURWINDS DR STE 335
Mailing Address - Street 2:
Mailing Address - City:WINDCREST
Mailing Address - State:TX
Mailing Address - Zip Code:78239-1925
Mailing Address - Country:US
Mailing Address - Phone:210-771-7195
Mailing Address - Fax:210-590-0355
Practice Address - Street 1:8930 FOURWINDS DR
Practice Address - Street 2:STE 335
Practice Address - City:WINDCREST
Practice Address - State:TX
Practice Address - Zip Code:78239-1970
Practice Address - Country:US
Practice Address - Phone:210-473-4246
Practice Address - Fax:210-590-0355
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-24
Last Update Date:2014-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX67821101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor