Provider Demographics
NPI:1386705382
Name:WALBURN, KATHRYN LYNN (LMHC)
Entity type:Individual
Prefix:MRS
First Name:KATHRYN
Middle Name:LYNN
Last Name:WALBURN
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:MISS
Other - First Name:KATHRYN
Other - Middle Name:LYNN
Other - Last Name:HYCHE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMHC
Mailing Address - Street 1:330 KAY LARKIN DRIVE
Mailing Address - Street 2:
Mailing Address - City:PALATKA
Mailing Address - State:FL
Mailing Address - Zip Code:32177
Mailing Address - Country:US
Mailing Address - Phone:386-329-3780
Mailing Address - Fax:386-329-3786
Practice Address - Street 1:330 KAY LARKIN DRIVE
Practice Address - Street 2:
Practice Address - City:PALATKA
Practice Address - State:FL
Practice Address - Zip Code:32177
Practice Address - Country:US
Practice Address - Phone:386-329-3780
Practice Address - Fax:386-329-3786
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH2551101YM0800X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL763928700Medicaid
FLMH2551OtherLICENSE #
FL762256200Medicaid
FLZ3748OtherBC/BS