Provider Demographics
NPI:1629892575
Name:WALTZ, LORA L (LMSW)
Entity type:Individual
Prefix:
First Name:LORA
Middle Name:L
Last Name:WALTZ
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4315 FEATHERSTON AVE
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76308-2622
Mailing Address - Country:US
Mailing Address - Phone:940-736-9139
Mailing Address - Fax:
Practice Address - Street 1:813 8TH ST STE 1000
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76301-3322
Practice Address - Country:US
Practice Address - Phone:940-736-9139
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-07
Last Update Date:2024-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX66866104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker