Provider Demographics
NPI:1760859151
Name:WALTMIRE, GINA MARIE (MS, LCMFT)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:MARIE
Last Name:WALTMIRE
Suffix:
Gender:F
Credentials:MS, LCMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6701 W 121ST ST STE 302
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66209-2034
Mailing Address - Country:US
Mailing Address - Phone:913-735-0033
Mailing Address - Fax:
Practice Address - Street 1:10100 W 87TH ST
Practice Address - Street 2:SUITE 209
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66212-4628
Practice Address - Country:US
Practice Address - Phone:913-735-0033
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-01
Last Update Date:2022-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2724106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist