Healthcare Provider Details

I. General information

NPI: 1831608280
Provider Name (Legal Business Name): PATRICIA JOAN WALKER LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2017
Last Update Date: 09/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

950 N 4TH ST
LONGVIEW TX
75601-5436
US

IV. Provider business mailing address

950 N 4TH ST
LONGVIEW TX
75601-5436
US

V. Phone/Fax

Practice location:
  • Phone: 903-757-1106
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number73939
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: