MEDICARE: KELLY CATHERINE WALKER RMHCI

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	IMH22361	FL

General Provider Information

NPI Number	:	1235997222
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLY CATHERINE WALKER RMHCI

Provider Business Mailing Address
First Line	:	807 SPENCER GROVE LN
Second Line	:
City	:	GLENSHAW
State	:	PA
Zip	:	15116-2377
Country	:	US
Telephone Number	:	412-508-6910
Fax Number	:

Provider Business Practice Location Address
First Line	:	1572 NE 191ST ST APT 340
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33179-4173
Country	:	US
Telephone Number	:	412-508-6910
Fax Number	:

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

Provider Enumeration Date	:	03/13/2024
Last Update Date	:	03/13/2024

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