=====================================================
General NPI Number Information
=====================================================
NPI Number | 1962078535
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WALKER THERAPY SERVICES L.L.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/03/2021
-----------------------------------------------------
Last Update Date | 06/03/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 250 E HORIZON DR STE 120
-----------------------------------------------------
City | HENDERSON
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89015-8059
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 801-872-9691
-----------------------------------------------------
Fax | 702-710-6574
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 250 E HORIZON DR STE 120
-----------------------------------------------------
City | HENDERSON
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89015-8059
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 801-872-9691
-----------------------------------------------------
Fax | 702-710-6574
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | PRESTON TENNEY WALKER
-----------------------------------------------------
Credential | LMFT
-----------------------------------------------------
Telephone | 801-554-4630
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM0801X
-----------------------------------------------------
Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------