Provider Demographics
NPI:1922111889
Name:WALPERT, MARCY E (MA)
Entity Type:Individual
Prefix:
First Name:MARCY
Middle Name:E
Last Name:WALPERT
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:MARTHA
Other - Middle Name:E
Other - Last Name:WALPERT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA,LPP
Mailing Address - Street 1:920 FREDERICA ST
Mailing Address - Street 2:SUITE 203
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42301-3050
Mailing Address - Country:US
Mailing Address - Phone:270-684-0077
Mailing Address - Fax:270-683-7962
Practice Address - Street 1:920 FREDERICA ST
Practice Address - Street 2:SUITE 203
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42301-3050
Practice Address - Country:US
Practice Address - Phone:270-684-0077
Practice Address - Fax:270-683-7962
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2014-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY030101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health