Provider Demographics
NPI:1750696522
Name:WALTERS, MICHELLE ALEXIS (LMFT)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:ALEXIS
Last Name:WALTERS
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:ALEXIS
Other - Middle Name:
Other - Last Name:WARD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMFT
Mailing Address - Street 1:6476 S IVY CT
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80111-4311
Mailing Address - Country:US
Mailing Address - Phone:408-460-0809
Mailing Address - Fax:
Practice Address - Street 1:26 W DRY CREEK CIR
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80120-8063
Practice Address - Country:US
Practice Address - Phone:408-460-0809
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-17
Last Update Date:2019-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA48798106H00000X
CO0001167106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist