Healthcare Provider Details

I. General information

NPI: 1083616973
Provider Name (Legal Business Name): ROBERT ALAN WALKER LCSW BCD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: ROBERT ALAN WALKER LCSW BCD

II. Dates (important events)

Enumeration Date: 08/11/2005
Last Update Date: 08/21/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 S RYAN ST 220
LAKE CHARLES LA
70601-5951
US

IV. Provider business mailing address

333 S. RYAN ST 220
LAKE CHARLES LA
70601-5951
US

V. Phone/Fax

Practice location:
  • Phone: 337-478-9331
  • Fax: 337-478-9828
Mailing address:
  • Phone: 337-478-9331
  • Fax: 337-478-9828

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number974
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: