Provider Demographics
NPI:1124120563
Name:WALTER, MARILYN JOYCE (MS,LPC,ATR-BC)
Entity type:Individual
Prefix:MRS
First Name:MARILYN
Middle Name:JOYCE
Last Name:WALTER
Suffix:
Gender:F
Credentials:MS,LPC,ATR-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17801 SYCAMORE ST
Mailing Address - Street 2:
Mailing Address - City:HOLT
Mailing Address - State:MO
Mailing Address - Zip Code:64048-8988
Mailing Address - Country:US
Mailing Address - Phone:816-320-3260
Mailing Address - Fax:
Practice Address - Street 1:1421 W 47TH ST
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64112-1103
Practice Address - Country:US
Practice Address - Phone:816-561-1622
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOCS002199101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health