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General NPI Number Information
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NPI Number | 1598406548
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Entity Type | Organization
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Legal Business Name | WALKER THERAPY LLC
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Dates
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Enumeration Date | 04/05/2022
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Last Update Date | 08/17/2022
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Provider Practice Location Address
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Address Line | 1640 LELIA DR STE 120
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City | JACKSON
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State | MS
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Zip | 39216-4873
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Country | US
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Telephone | 601-914-4492
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Fax | 601-914-6715
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Provider Business Mailing Address
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Address Line | 1640 LELIA DR STE 120
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City | JACKSON
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State | MS
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Zip | 39216-4873
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | MR. IAN D WALKER
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Credential | MS, LPC, BC-TMH
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Telephone | 601-914-4492
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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