Healthcare Provider Details

I. General information

NPI: 1821801739
Provider Name (Legal Business Name): MR. MICHAEL WALKER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/27/2025
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

691 ZANJA ST
PASADENA CA
91103-2462
US

IV. Provider business mailing address

691 ZANJA ST
PASADENA CA
91103-2462
US

V. Phone/Fax

Practice location:
  • Phone: 626-664-4302
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number21610
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: