Healthcare Provider Details

I. General information

NPI: 1215471651
Provider Name (Legal Business Name): RICKY WALKER M.ED LPCC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/04/2016
Last Update Date: 04/06/2023
Certification Date: 04/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2375 PROFESSIONAL HEIGHTS DR STE 240
LEXINGTON KY
40503
US

IV. Provider business mailing address

2375 PROFESSIONAL HEIGHTS DR STE 240
LEXINGTON KY
40503-3040
US

V. Phone/Fax

Practice location:
  • Phone: 855-591-0092
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number171807
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: