Healthcare Provider Details

I. General information

NPI: 1497857452
Provider Name (Legal Business Name): SHIRLEY A WALKER LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MISS SHIRLEY ANN BRIDGES

II. Dates (important events)

Enumeration Date: 09/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

216C NORTH MAIN STREET
TRENTON FL
32693
US

IV. Provider business mailing address

PO BOX 2076
TRENTON FL
32693
US

V. Phone/Fax

Practice location:
  • Phone: 352-463-7766
  • Fax: 352-463-7245
Mailing address:
  • Phone: 352-463-7766
  • Fax: 352-463-7245

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH3007
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: