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NPI Code Detail

MEDICARE: MR. MICHAEL THEODORE WALKER MSW, QMHP

MEDICARE: MR. MICHAEL THEODORE WALKER MSW, QMHP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor
21041C0700XClinical Social Worker

General Provider Information

NPI Number : 1396810875
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. MICHAEL THEODORE WALKER MSW, QMHP
Provider Business Mailing Address
First Line : PO BOX 343
Second Line :
City : TILLAMOOK
State : OR
Zip : 97141-0343
Country : US
Telephone Number : 503-842-4650
Fax Number : 800-785-5748
Provider Business Practice Location Address
First Line : 2330 NE SISKIYOU ST
Second Line :
City : PORTLAND
State : OR
Zip : 97212-2471
Country : US
Telephone Number : 503-528-0757
Fax Number : 503-528-0764
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/21/2006
Last Update Date : 11/26/2008

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