Provider Demographics
NPI:1578045670
Name:WALTERS, KRIS-ANN (LMHC)
Entity Type:Individual
Prefix:
First Name:KRIS-ANN
Middle Name:
Last Name:WALTERS
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4001 OFFICE COURT DR STE 102
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87507-4903
Mailing Address - Country:US
Mailing Address - Phone:505-395-9437
Mailing Address - Fax:505-395-7406
Practice Address - Street 1:4001 OFFICE COURT DR STE 102
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87507-4903
Practice Address - Country:US
Practice Address - Phone:505-395-9437
Practice Address - Fax:505-395-7406
Is Sole Proprietor?:No
Enumeration Date:2018-09-05
Last Update Date:2018-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMT-CTL0197171101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health