Healthcare Provider Details

I. General information

NPI: 1306309455
Provider Name (Legal Business Name): RENEE KATHLEEN WALKER LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2019
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

805 W 10TH ST
MESA AZ
85201-3921
US

IV. Provider business mailing address

805 W 10TH ST
MESA AZ
85201-3921
US

V. Phone/Fax

Practice location:
  • Phone: 480-772-1421
  • Fax:
Mailing address:
  • Phone: 480-772-1421
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number18592
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: