MEDICARE: KRISTINA MICHELLE WATERS LCSW, LMFT

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	106H00000X	Marriage & Family Therapist	260578	KY
2	1041C0700X	Clinical Social Worker	256442	KY

General Provider Information

NPI Number	:	1427540160
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTINA MICHELLE WATERS LCSW, LMFT

Provider Business Mailing Address
First Line	:	1330 ELLISON AVE
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40204-1657
Country	:	US
Telephone Number	:	502-694-9488
Fax Number	:

Provider Business Practice Location Address
First Line	:	1330 ELLISON AVE
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40204-1657
Country	:	US
Telephone Number	:	502-694-9488
Fax Number	:

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

Provider Enumeration Date	:	05/30/2018
Last Update Date	:	02/27/2024

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