Provider Demographics
NPI:1891026191
Name:WALTERS, KATIE (BHRS)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:
Last Name:WALTERS
Suffix:
Gender:F
Credentials:BHRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:323 W 6TH ST
Mailing Address - Street 2:
Mailing Address - City:OKMULGEE
Mailing Address - State:OK
Mailing Address - Zip Code:74447-5019
Mailing Address - Country:US
Mailing Address - Phone:918-756-9411
Mailing Address - Fax:
Practice Address - Street 1:100 N 5TH ST
Practice Address - Street 2:
Practice Address - City:MCALESTER
Practice Address - State:OK
Practice Address - Zip Code:74501-5084
Practice Address - Country:US
Practice Address - Phone:918-420-5343
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-26
Last Update Date:2012-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health