Individual
MISTY LYNN WALTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
57 DORA LANE, GREENUP, KY 41144
(606) 473-7333
(606) 473-7335
Mailing address
900 BEASLEY ST, LEXINGTON, KY 40509-4266
(859) 254-1035
(859) 254-2075
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
1258
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000346980
ANTHEM BCBS
—
01
—
11688094
CAQH
—
01
—
1221659
CHA
—
01
—
1982615043
GRP NPI
—
05
—
30610026
—
KY
01
—
P00372124
PALMETTO - RR MCR
—
Enumeration date
07/21/2006
Last updated
04/21/2025
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