Healthcare Provider Details

I. General information

NPI: 1265018634
Provider Name (Legal Business Name): EMMA WALTERS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2021
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3900 LAKELAND DR STE 510
FLOWOOD MS
39232-8854
US

IV. Provider business mailing address

3900 LAKELAND DR STE 510
FLOWOOD MS
39232-8854
US

V. Phone/Fax

Practice location:
  • Phone: 769-225-4743
  • Fax:
Mailing address:
  • Phone: 769-225-4743
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2883
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: