=====================================================
General NPI Number Information
=====================================================
NPI Number | 1427459825
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SUAVE R WALKER MS
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/04/2014
-----------------------------------------------------
Last Update Date | 09/04/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 15100 NW 27TH AVE
-----------------------------------------------------
City | OPA LOCKA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33054-2642
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-685-8201
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1255 SW 101ST TER APT 307
-----------------------------------------------------
City | PEMBROKE PINES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33025-5047
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-663-4389
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | IMT 1983
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------