Marlo Ellis Walters, PSY.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

200141871A Issued in IN

Practice address

2837 Satin Leaf Park
Lexington, KY 40511-8962

Phone

(850) 377-4752

NPI assigned

Dec 22, 2022

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Grow Healthcare Group PA

  • Mental Health Counselor
  • Miami, FL
  • NPI 1245845932

  IN

  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1671667200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1671667200000",
    "number": "1952013856",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2837 SATIN LEAF PARK",
            "city": "LEXINGTON",
            "state": "KY",
            "postal_code": "405118962",
            "telephone_number": "850-377-4752"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2837 SATIN LEAF PARK",
            "city": "LEXINGTON",
            "state": "KY",
            "postal_code": "405118962",
            "telephone_number": "850-377-4752"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALTERS",
        "first_name": "MARLO",
        "middle_name": "ELLIS",
        "name_prefix": "Dr.",
        "credential": "PSY.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-12-22",
        "last_updated": "2022-12-22",
        "certification_date": "2022-12-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "IN",
            "license": "200141871A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Billie J Walters, ACNP-BC
• Jake Walters
• Lisa Marie Walters, OTR/L, CHT
• Mandy Jay Walters, APRN, FNP-C
• Maria Walters, ARPN, FNP-C
• Melissa R Walters, APRN
• Samuel Walters, PT
• Suzanne Michele Walters, RN
• Tabatha Walters
• Tiffany Walters, NCPRSS

• Clinical Psychologist in Lexington, KY
• Providers in Lexington, KY by specialty
• Clinical Psychologist in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 22, 2022; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.