Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor |
NPI | 1003001744 |
---|---|
Provider Name | Ron Walden |
First Address | Durango, CO 81301-6582 |
Second Address | Farmington, NM 87401-4559 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/09/2007 |
Last Update Date | 21/09/2009 |