Provider Demographics
NPI:1043651607
Name:WALTHER, JACQUELYN ANN (MA, CI, NCC)
Entity type:Individual
Prefix:MRS
First Name:JACQUELYN
Middle Name:ANN
Last Name:WALTHER
Suffix:
Gender:F
Credentials:MA, CI, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3005 HARVARD AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70006-6401
Mailing Address - Country:US
Mailing Address - Phone:504-915-0147
Mailing Address - Fax:877-471-3808
Practice Address - Street 1:3005 HARVARD AVE STE 201
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70006-6401
Practice Address - Country:US
Practice Address - Phone:504-915-0147
Practice Address - Fax:877-471-3808
Is Sole Proprietor?:No
Enumeration Date:2013-07-11
Last Update Date:2023-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional