Provider Demographics
NPI:1992526768
Name:WALTERS, REBECCA J (LMHCA)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:J
Last Name:WALTERS
Suffix:
Gender:F
Credentials:LMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1320 N FRANKLIN RD
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-3917
Mailing Address - Country:US
Mailing Address - Phone:317-750-9628
Mailing Address - Fax:
Practice Address - Street 1:1320 N FRANKLIN RD
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46219-3917
Practice Address - Country:US
Practice Address - Phone:317-750-9628
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-23
Last Update Date:2024-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN99127046A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health