Healthcare Provider Details

I. General information

NPI: 1619833936
Provider Name (Legal Business Name): MS. KIRA NICOLE WALTZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/30/2025
Last Update Date: 12/30/2025
Certification Date: 12/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

126 WELLINGTON PL
CINCINNATI OH
45219-1710
US

IV. Provider business mailing address

126 WELLINGTON PL
CINCINNATI OH
45219-1710
US

V. Phone/Fax

Practice location:
  • Phone: 513-268-8306
  • Fax: 513-880-0836
Mailing address:
  • Phone: 513-268-8306
  • Fax: 513-880-0836

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberC.2507192-TRNE
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: