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General NPI Number Information
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NPI Number | 1215488648
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Entity Type | Organization
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Legal Business Name | THE WALKER WELLNESS CLINIC
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Dates
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Enumeration Date | 10/20/2016
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Last Update Date | 10/20/2016
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Provider Practice Location Address
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Address Line | 12200 PRESTON RD.
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City | DALLAS
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State | TX
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Zip | 75230
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Country | US
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Telephone | 214-521-8969
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Fax |
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Provider Business Mailing Address
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Address Line | 12200 PRESTON RD
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City | DALLAS
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State | TX
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Zip | 75230-2223
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Country | US
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Telephone | 214-521-8969
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. SUSAN WALKER
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Credential | M.S., LPC
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Telephone | 214-521-8969
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 9515
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License Number State | TX
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