Healthcare Provider Details

I. General information

NPI: 1043656226
Provider Name (Legal Business Name): STEPHEN WALKER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2013
Last Update Date: 05/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 HARRIS SPRINGS RD
LAS VEGAS NV
89124-9215
US

IV. Provider business mailing address

6612 BRANDYWINE WAY
LAS VEGAS NV
89107-3341
US

V. Phone/Fax

Practice location:
  • Phone: 702-872-5382
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: