Healthcare Provider Details

I. General information

NPI: 1588090542
Provider Name (Legal Business Name): SEAN PAUL WALKER B.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2013
Last Update Date: 03/23/2021
Certification Date: 03/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 HUGHES WAY SUIT 150
LONG BEACH CA
90810-1876
US

IV. Provider business mailing address

947 COLE AVE FL 2
LOS ANGELES CA
90038-2610
US

V. Phone/Fax

Practice location:
  • Phone: 310-221-6336
  • Fax:
Mailing address:
  • Phone: 323-871-4650
  • Fax: 323-463-8141

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number104324
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number225400000X
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: