Healthcare Provider Details

I. General information

NPI: 1609234640
Provider Name (Legal Business Name): JUSTIN WALKER LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/05/2016
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

545 N BENJAMIN LN STE 185
BOISE ID
83704-9625
US

IV. Provider business mailing address

3479 E BERGHAN ST
MERIDIAN ID
83642-5712
US

V. Phone/Fax

Practice location:
  • Phone: 208-724-6737
  • Fax:
Mailing address:
  • Phone: 208-724-6737
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW-35317
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: