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General NPI Number Information
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NPI Number | 1417342957
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Entity Type | Individual
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Provider Name | CHARLES ELMER WALKER LMFT
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Gender | Male
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Dates
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Enumeration Date | 04/01/2015
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Last Update Date | 10/01/2022
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Provider Practice Location Address
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Address Line | 1665 PRECISION PARK LN STE H
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City | SAN YSIDRO
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State | CA
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Zip | 92173-1348
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Country | US
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Telephone | 619-330-7569
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Fax |
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Provider Business Mailing Address
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Address Line | 654 E SAN YSIDRO BLVD STE 483
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City | SAN YSIDRO
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State | CA
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Zip | 92173-3151
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Country | US
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Telephone | 619-330-7569
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 111585
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License Number State | CA
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