Active NPI
Derricia Walters
- Mental Health Counselor
- Fort Wayne, IN
National Provider Identifier
1427740885
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 39005938A
- Practice address
- 1010 E Dupont Rd
Fort Wayne, IN 46825-1554 - Phone
- (260) 471-8141
- NPI assigned
- May 24, 2023
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 39005938A | IN | Primary |
Addresses
Primary practice location
1010 E Dupont Rd
Fort Wayne, IN 46825-1554
Mailing address
5402 S Calhoun St
Fort Wayne, IN 46807-3317
Phone (260) 206-4424
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Care Compare profile
Medicare Care Compare- Specialty
- Mental Health Counselor
- Education
- Other, 2023
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
535 Mack Ave
Kingsley, MI 49649-9220
5402 S Calhoun St
Fort Wayne, IN 46807-3317
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 39005938A | IN | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1684886400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1774396800000",
"number": "1427740885",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5402 S CALHOUN ST",
"city": "FORT WAYNE",
"state": "IN",
"postal_code": "468073317",
"telephone_number": "260-206-4424"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1010 E DUPONT RD",
"city": "FORT WAYNE",
"state": "IN",
"postal_code": "468251554",
"telephone_number": "260-471-8141"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALTERS",
"first_name": "DERRICIA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-05-24",
"last_updated": "2026-03-25",
"certification_date": "2026-03-25",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "IN",
"license": "39005938A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Wayne, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 25, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.