Provider Demographics
NPI:1689235004
Name:WALTERS, BRANDY J (MED, LPCA)
Entity Type:Individual
Prefix:MRS
First Name:BRANDY
Middle Name:J
Last Name:WALTERS
Suffix:
Gender:F
Credentials:MED, LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 S HIGHWAY 1651
Mailing Address - Street 2:
Mailing Address - City:WHITLEY CITY
Mailing Address - State:KY
Mailing Address - Zip Code:42653-6150
Mailing Address - Country:US
Mailing Address - Phone:606-875-7532
Mailing Address - Fax:
Practice Address - Street 1:510 S HIGHWAY 1651
Practice Address - Street 2:
Practice Address - City:WHITLEY CITY
Practice Address - State:KY
Practice Address - Zip Code:42653-6150
Practice Address - Country:US
Practice Address - Phone:606-875-7532
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-26
Last Update Date:2019-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY127136101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional