MEDICARE: DR. BRIAN JENS WALKER PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	1089	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1089	OTHER	AZ	AZ STATE LICENSE NUMBER

General Provider Information

NPI Number	:	1285702530
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRIAN JENS WALKER PH.D.

Provider Business Mailing Address
First Line	:	PO BOX 12644
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85732-2644
Country	:	US
Telephone Number	:	520-747-0821
Fax Number	:	520-790-5175

Provider Business Practice Location Address
First Line	:	5151 E. BROADWAY BOULEVARD
Second Line	:	SUITE 720
City	:	TUCSON
State	:	AZ
Zip	:	85711-3783
Country	:	US
Telephone Number	:	520-747-0821
Fax Number	:	520-790-5175

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/02/2006
Last Update Date	:	07/08/2007

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