Provider Demographics
NPI:1275678146
Name:WALKER, KELLY RENEE (LMFT)
Entity type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:RENEE
Last Name:WALKER
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1660 N TYLER RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67212-1505
Mailing Address - Country:US
Mailing Address - Phone:316-648-9572
Mailing Address - Fax:316-773-5430
Practice Address - Street 1:1660 N TYLER RD
Practice Address - Street 2:SUITE A
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67212-1505
Practice Address - Country:US
Practice Address - Phone:316-648-9572
Practice Address - Fax:316-773-5430
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS646106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist