Healthcare Provider Details

I. General information

NPI: 1124771795
Provider Name (Legal Business Name): ELIZABETH TOWNSEND WALKER LCSW, EDD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: BETH WALKER LCSW

II. Dates (important events)

Enumeration Date: 02/02/2022
Last Update Date: 02/02/2022
Certification Date: 02/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 W 6TH ST
SILVER CITY NM
88061-4101
US

IV. Provider business mailing address

1001 W 6TH ST
SILVER CITY NM
88061-4101
US

V. Phone/Fax

Practice location:
  • Phone: 575-654-5881
  • Fax:
Mailing address:
  • Phone: 575-654-5881
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC-06148
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: