Provider Demographics
NPI:1073211900
Name:WALTER, KRISTY LYNN (ATR-BC)
Entity type:Individual
Prefix:
First Name:KRISTY
Middle Name:LYNN
Last Name:WALTER
Suffix:
Gender:F
Credentials:ATR-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:558 BLANK SCHOOL RD
Mailing Address - Street 2:
Mailing Address - City:GREENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15601-1469
Mailing Address - Country:US
Mailing Address - Phone:330-303-0648
Mailing Address - Fax:
Practice Address - Street 1:1 NORTHGATE SQ STE 218
Practice Address - Street 2:
Practice Address - City:GREENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15601-1374
Practice Address - Country:US
Practice Address - Phone:330-303-0648
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-20
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA22-112221700000X
PAPC015450101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist