Healthcare Provider Details

I. General information

NPI: 1316383011
Provider Name (Legal Business Name): LYNNITA JOYCE WALKER LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2013
Last Update Date: 02/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 LLAMA
SEARCY AR
72143
US

IV. Provider business mailing address

1815 PLESANT GROVE ROAD
JONESBORO AR
72404
US

V. Phone/Fax

Practice location:
  • Phone: 501-305-2359
  • Fax: 501-305-2348
Mailing address:
  • Phone: 870-933-6886
  • Fax: 870-933-9395

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberA1302011
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: