Healthcare Provider Details

I. General information

NPI: 1376857375
Provider Name (Legal Business Name): WALTER VINCENT WINN MA, LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2010
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2015 S HALLIBURTON ST
KIRKSVILLE MO
63501-4646
US

IV. Provider business mailing address

PO BOX 844715
KANSAS CITY MO
64184-4715
US

V. Phone/Fax

Practice location:
  • Phone: 660-626-0698
  • Fax:
Mailing address:
  • Phone: 417-761-5000
  • Fax: 417-761-5631

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2000146843
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: