Provider Demographics
NPI:1457566275
Name:WALTER, KAREENA LYNN (MSW, LCSW)
Entity Type:Individual
Prefix:MS
First Name:KAREENA
Middle Name:LYNN
Last Name:WALTER
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:MS
Other - First Name:KAREEN
Other - Middle Name:LYNN
Other - Last Name:WALTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:317 S OLD STAGE RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT SHASTA
Mailing Address - State:CA
Mailing Address - Zip Code:96067-9742
Mailing Address - Country:US
Mailing Address - Phone:530-918-7205
Mailing Address - Fax:530-918-7216
Practice Address - Street 1:2060 CAMPUS DR
Practice Address - Street 2:
Practice Address - City:YREKA
Practice Address - State:CA
Practice Address - Zip Code:96097-9538
Practice Address - Country:US
Practice Address - Phone:530-918-7205
Practice Address - Fax:530-918-7216
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2012-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 179831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1457566275Medicare PIN