Active NPI
Kelly David Walters, LMHCA
- Mental Health Counselor
- Spokane, WA
National Provider Identifier
1902384704
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 60776492
- Practice address
- 316 W Boone Ave Ste 577
Spokane, WA 99201-2346 - Phone
- (509) 385-8505
- NPI assigned
- Aug 2, 2018
- Sex
- Male
- 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 | 60776492 | WA | Primary |
Addresses
Primary practice location
316 W Boone Ave Ste 577
Spokane, WA 99201-2346
Mailing address
3120 S Grand Blvd Unit 8473
Spokane, WA 99203-2681
Phone (509) 570-5155
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Feb 12, 2024 through Feb 12, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 60776492 | WA | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1533168000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1533168000000",
"number": "1902384704",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3120 S GRAND BLVD UNIT 8473",
"city": "SPOKANE",
"state": "WA",
"postal_code": "992032681",
"telephone_number": "509-570-5155"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "316 W BOONE AVE STE 577",
"city": "SPOKANE",
"state": "WA",
"postal_code": "992012346",
"telephone_number": "509-385-8505"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALTERS",
"first_name": "KELLY",
"middle_name": "DAVID",
"credential": "LMHCA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2018-08-02",
"last_updated": "2018-08-02",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "WA",
"license": "60776492",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Spokane, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 2, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.