=====================================================
General NPI Number Information
=====================================================
NPI Number | 1922989086
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JEREMY WALKER LPC
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/08/2025
-----------------------------------------------------
Last Update Date | 09/25/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4810 N COUNTY ROAD 2800
-----------------------------------------------------
City | LUBBOCK
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 79403-7297
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 806-747-3187
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1423 10TH ST
-----------------------------------------------------
City | SHALLOWATER
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 79363-5137
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | 93037
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------