Walter David Revoal, M.A, L.P.C

Primary specialty

CounselorTaxonomy code 101Y00000X

License

2103 Issued in CO

Practice address

834 S Sherman St
Longmont, CO 80501-6323

Phone

(303) 776-7840

Fax

(303) 776-7161

NPI assigned

Sep 15, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Arts

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1158278400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1932205143",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3757 STUART ST",
            "city": "DENVER",
            "state": "CO",
            "postal_code": "802121921",
            "telephone_number": "303-455-3288"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "834 S SHERMAN ST",
            "city": "LONGMONT",
            "state": "CO",
            "postal_code": "805016323",
            "telephone_number": "303-776-7840",
            "fax_number": "303-776-7161"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REVOAL",
        "first_name": "WALTER",
        "middle_name": "DAVID",
        "credential": "M.A, L.P.C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-15",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "CO",
            "license": "2103",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Counselor in Longmont, CO
• Providers in Longmont, CO by specialty
• Counselor in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.