Healthcare Provider Details

I. General information

NPI: 1144821679
Provider Name (Legal Business Name): ELYSHA WALKER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2020
Last Update Date: 12/28/2022
Certification Date: 12/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

465 SE RIVERSIDE DR
STUART FL
34994-2584
US

IV. Provider business mailing address

465 SE RIVERSIDE DR
STUART FL
34994-2584
US

V. Phone/Fax

Practice location:
  • Phone: 772-207-0716
  • Fax:
Mailing address:
  • Phone: 772-678-8775
  • Fax:

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: