MEDICARE: MADDIE ANN WALTMAN LPCC, LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	CDCA.130897	OH
2	101YA0400X	Addiction (Substance Use Disorder) Counselor	274636	KY
3	101YA0400X	Addiction (Substance Use Disorder) Counselor	ADC.00000128	OH
4	101YA0400X	Addiction (Substance Use Disorder) Counselor	LCDCIII.161165	OH
5	101YM0800X	Mental Health Counselor	C.2304729-TRNE	OH
6	101YM0800X	Mental Health Counselor	C.2406163	OH
7	101YM0800X	Mental Health Counselor	292469	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1629407911
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MADDIE ANN WALTMAN LPCC, LPC

Provider Business Mailing Address
First Line	:	71 CAVALIER BLVD STE 313
Second Line	:
City	:	FLORENCE
State	:	KY
Zip	:	41042-5172
Country	:	US
Telephone Number	:	859-302-9877
Fax Number	:

Provider Business Practice Location Address
First Line	:	71 CAVALIER BLVD STE 313
Second Line	:
City	:	FLORENCE
State	:	KY
Zip	:	41042-5172
Country	:	US
Telephone Number	:	859-302-9877
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/06/2013
Last Update Date	:	10/25/2024

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