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General NPI Number Information
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NPI Number | 1033234976
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Entity Type | Organization
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Legal Business Name | G. GARY WALKER, PH.D., P.C.
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Dates
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Enumeration Date | 03/20/2007
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Last Update Date | 10/25/2022
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Provider Practice Location Address
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Address Line | 5120 29TH DR STE D
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City | LUBBOCK
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State | TX
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Zip | 79407-2612
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Country | US
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Telephone | 806-798-8855
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Fax | 806-792-5715
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Provider Business Mailing Address
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Address Line | 5203 28TH ST
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City | LUBBOCK
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State | TX
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Zip | 79407-3507
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Country | US
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Telephone | 806-798-8855
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Fax | 806-798-8855
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Authorized Official
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Title or Position | PRESIDENT OF THE CORPORATION
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Name | GEORGE GARY WALKER
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Credential | PH.D.
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Telephone | 806-798-8855
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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