Healthcare Provider Details

I. General information

NPI: 1124375837
Provider Name (Legal Business Name): MS. NATACHA WALKER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2012
Last Update Date: 08/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4450 WEST EAU GALLIE BLVD 200
MELBOURNE FL
32935-9998
US

IV. Provider business mailing address

400 SHERIDAN RD
MELBOURNE FL
32901-3122
US

V. Phone/Fax

Practice location:
  • Phone: 321-726-2860
  • Fax:
Mailing address:
  • Phone: 321-722-5200
  • Fax: 321-953-7510

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: