MEDICARE: MICHELLE L WALKER LMFT

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	106H00000X	Marriage & Family Therapist	112859	CA

General Provider Information

NPI Number	:	1306067897
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE L WALKER LMFT

Provider Business Mailing Address
First Line	:	1653 MENTONE AVE
Second Line	:
City	:	GROVER BEACH
State	:	CA
Zip	:	93433-2908
Country	:	US
Telephone Number	:	805-748-2738
Fax Number	:

Provider Business Practice Location Address
First Line	:	1653 MENTONE AVE
Second Line	:
City	:	GROVER BEACH
State	:	CA
Zip	:	93433-2908
Country	:	US
Telephone Number	:	180-574-8273
Fax Number	:	805-925-9706

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

Provider Enumeration Date	:	05/01/2007
Last Update Date	:	11/01/2023

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