Individual
MR. KEITH MICHAEL WALACH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LPC, CAC
Contact information
Practice address
2863 STATE ROUTE 45 N, ROCK CREEK, OH 44084-9352
(800) 234-1001
(440) 563-9619
Mailing address
PO BOX 298, ROCK CREEK, OH 44084-0298
(800) 234-1001
(814) 451-2348
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
PC002699
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001450499
HIGHMARK ID
PA
Enumeration date
10/17/2006
Last updated
06/29/2023
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