Healthcare Provider Details

I. General information

NPI: 1417759853
Provider Name (Legal Business Name): LARRY WALKER LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2025
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2653 N KEDZIE AVE
CHICAGO IL
60647-1607
US

IV. Provider business mailing address

2633 N FAIRFIELD AVE
CHICAGO IL
60647-1825
US

V. Phone/Fax

Practice location:
  • Phone: 773-377-5577
  • Fax:
Mailing address:
  • Phone: 773-954-6896
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180.018175
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number178.020040
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: