Provider Demographics
NPI:1376518506
Name:WALTERS, PHYLLIS KUEHNL (PHD)
Entity Type:Individual
Prefix:DR
First Name:PHYLLIS
Middle Name:KUEHNL
Last Name:WALTERS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:73 VILLA POINTE DR
Mailing Address - Street 2:
Mailing Address - City:SPRINGBORO
Mailing Address - State:OH
Mailing Address - Zip Code:45066-8308
Mailing Address - Country:US
Mailing Address - Phone:937-886-0312
Mailing Address - Fax:
Practice Address - Street 1:28 E RAHN RD
Practice Address - Street 2:SUITE 207
Practice Address - City:KETTERING
Practice Address - State:OH
Practice Address - Zip Code:45429-5461
Practice Address - Country:US
Practice Address - Phone:937-219-1143
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist