Doctor Name: | MRS. LAURA MARIE WALTS |
NPI Number: | 1003187477 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | M.A., LPC |
License Number: | C0800173 |
Business Practice Address: | 41641 N Ridge Rd Suite B Elyria, OH - 440351245 |
Business Phone Number: | 4402131166 |
Business Fax Number: | |
Mailing Address: | 41641 N Ridge Rd, Suite B ELYRIA |
State: | OH |
Postal Code: | 440351245 |
Phone Number: | 4402606110 |
Fax Number: | |
NPI Enumeration Date: | 01/18/2012 |
NPI Last Update Date: | 01/18/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | C0800173 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | OH |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |