MEDICARE: MRS. MARILYN JOYCE WALTER MS,LPC,ATR-BC

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	CS002199	MO

General Provider Information

NPI Number	:	1124120563
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARILYN JOYCE WALTER MS,LPC,ATR-BC

Provider Business Mailing Address
First Line	:	17801 SYCAMORE ST
Second Line	:
City	:	HOLT
State	:	MO
Zip	:	64048-8988
Country	:	US
Telephone Number	:	816-320-3260
Fax Number	:

Provider Business Practice Location Address
First Line	:	1421 W 47TH ST
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64112-1103
Country	:	US
Telephone Number	:	816-561-1622
Fax Number	:

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

Provider Enumeration Date	:	09/05/2006
Last Update Date	:	07/08/2007

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