Provider Demographics
NPI:1568851889
Name:WALDEN BEHAVIOR SOLUTIONS, LLC
Entity Type:Organization
Organization Name:WALDEN BEHAVIOR SOLUTIONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KATIE
Authorized Official - Middle Name:SIAS
Authorized Official - Last Name:WILKINSON
Authorized Official - Suffix:
Authorized Official - Credentials:MS, BCBA, LBA
Authorized Official - Phone:502-915-8796
Mailing Address - Street 1:9900 SHELBYVILLE RD STE 8
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40223-2965
Mailing Address - Country:US
Mailing Address - Phone:502-915-8796
Mailing Address - Fax:502-805-0765
Practice Address - Street 1:9900 SHELBYVILLE RD STE 8
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40223-2965
Practice Address - Country:US
Practice Address - Phone:502-915-8796
Practice Address - Fax:502-805-0765
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-12
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY101584103K00000X
KY0906666251S00000X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100338500Medicaid
KY7100455710OtherSCL MEDICAID WAIVER
KY7100467300Medicaid
KY7100467300Medicaid