Provider Demographics
NPI:1356747943
Name:WALTERS, CHYENNE MARIE
Entity type:Individual
Prefix:
First Name:CHYENNE
Middle Name:MARIE
Last Name:WALTERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CHYENNE
Other - Middle Name:MARIE
Other - Last Name:LEACH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:40 W 300 S
Mailing Address - Street 2:
Mailing Address - City:SPRINGVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84663-1329
Mailing Address - Country:US
Mailing Address - Phone:719-994-7645
Mailing Address - Fax:
Practice Address - Street 1:580 E 600 S
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84606-4806
Practice Address - Country:US
Practice Address - Phone:801-373-7443
Practice Address - Fax:801-356-0322
Is Sole Proprietor?:No
Enumeration Date:2014-11-10
Last Update Date:2023-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician