Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | C0800173 | OH |
NPI | 1003187477 |
---|---|
Provider Name | Mrs. Laura Marie Walts |
First Address | Elyria, OH 44035-1245 |
Second Address | Elyria, OH 44035-1245 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/01/2012 |
Last Update Date | 18/01/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
340720558 | (05) | OH |