Provider Demographics
NPI:1104239961
Name:WALTER, KAYLA (MA, LPC)
Entity type:Individual
Prefix:MRS
First Name:KAYLA
Middle Name:
Last Name:WALTER
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:MISS
Other - First Name:KAYLA
Other - Middle Name:
Other - Last Name:KOVACH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BA
Mailing Address - Street 1:202 E BAGLEY RD
Mailing Address - Street 2:
Mailing Address - City:BEREA
Mailing Address - State:OH
Mailing Address - Zip Code:44017-2058
Mailing Address - Country:US
Mailing Address - Phone:440-234-2006
Mailing Address - Fax:440-243-0787
Practice Address - Street 1:16101 SNOW RD
Practice Address - Street 2:SUITE 101
Practice Address - City:BROOKPARK
Practice Address - State:OH
Practice Address - Zip Code:44142-2817
Practice Address - Country:US
Practice Address - Phone:216-644-1706
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-09
Last Update Date:2014-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.1300024101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional