Healthcare Provider Details

I. General information

NPI: 1285571695
Provider Name (Legal Business Name): WILLIAM EDWARD WALKUP LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/02/2026
Last Update Date: 05/02/2026
Certification Date: 05/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 UNIVERSITY AVE
BOLIVAR MO
65613-2578
US

IV. Provider business mailing address

4625 S 145TH RD
BOLIVAR MO
65613-8465
US

V. Phone/Fax

Practice location:
  • Phone: 417-399-3400
  • Fax:
Mailing address:
  • Phone: 417-399-3400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW1669
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: