Healthcare Provider Details

I. General information

NPI: 1851882054
Provider Name (Legal Business Name): JOHNNY WALKER LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2018
Last Update Date: 03/20/2026
Certification Date: 03/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 2491
HARVEY LA
70059-2491
US

IV. Provider business mailing address

PO BOX 2491
HARVEY LA
70059-2491
US

V. Phone/Fax

Practice location:
  • Phone: 318-791-3924
  • Fax:
Mailing address:
  • Phone: 318-791-3924
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number13945
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number13945
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number13945
License Number StateLA
# 4
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number115131
License Number StateTX
# 5
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number14194268-3501
License Number StateUT
# 6
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberTPSW5306
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: