Healthcare Provider Details

I. General information

NPI: 1104740810
Provider Name (Legal Business Name): BEVERLY MICHELLE WALKER LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2026
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3517 TRYON RD
LONGVIEW TX
75605-8310
US

IV. Provider business mailing address

5805 FM 3358
GILMER TX
75645-8270
US

V. Phone/Fax

Practice location:
  • Phone: 903-252-4673
  • Fax:
Mailing address:
  • Phone: 903-932-9233
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number83584
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: