MEDICARE: RUSS WALKER LPC-A

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	101YP2500X	Professional Counselor	94056	TX

General Provider Information

NPI Number	:	1881456648
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RUSS WALKER LPC-A

Provider Business Mailing Address
First Line	:	1339 LAMAR SQUARE DRIVE
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78704-2209
Country	:	US
Telephone Number	:	512-443-5777
Fax Number	:	855-978-1775

Provider Business Practice Location Address
First Line	:	1339 LAMAR SQUARE DRIVE
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78704-2209
Country	:	US
Telephone Number	:	512-443-5777
Fax Number	:	855-978-1775

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

Provider Enumeration Date	:	01/26/2024
Last Update Date	:	01/26/2024

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Directions to “ RUSS WALKER LPC-A” Practice Location

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