MEDICARE: KAYLIN AMANDA WALTERS

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	101YM0800X	Mental Health Counselor	APC008275	GA

General Provider Information

NPI Number	:	1104507029
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAYLIN AMANDA WALTERS

Provider Business Mailing Address
First Line	:	670 DEKALB AVE SE UNIT 2436
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30312-2032
Country	:	US
Telephone Number	:	770-503-4762
Fax Number	:

Provider Business Practice Location Address
First Line	:	3801 BRIARCLIFF RD NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30345-3856
Country	:	US
Telephone Number	:	678-874-6702
Fax Number	:

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

Provider Enumeration Date	:	07/25/2023
Last Update Date	:	07/25/2023

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