Healthcare Provider Details

I. General information

NPI: 1194947721
Provider Name (Legal Business Name): ALICE ELIZABETH WALKER LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 10/16/2024
Certification Date: 10/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11603 ROAD 27.3
DOLORES CO
81323-9249
US

IV. Provider business mailing address

11603 ROAD 27.3
DOLORES CO
81323-9249
US

V. Phone/Fax

Practice location:
  • Phone: 502-439-6410
  • Fax:
Mailing address:
  • Phone: 502-439-6410
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC.0017090
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberKY-0590
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: