Healthcare Provider Details

I. General information

NPI: 1992638126
Provider Name (Legal Business Name): BRYCESTON K WALKER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2026
Last Update Date: 06/06/2026
Certification Date: 06/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2439 MANHATTAN BLVD STE 207
HARVEY LA
70058-5361
US

IV. Provider business mailing address

650 RICKS PL
NEW ORLEANS LA
70114-5954
US

V. Phone/Fax

Practice location:
  • Phone: 504-364-8949
  • Fax:
Mailing address:
  • Phone: 504-208-8401
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: