MEDICARE: SHERITA WALKER

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number State
1	106S00000X	Behavior Technician	AZ
2	101Y00000X	Counselor
3	101YA0400X	Addiction (Substance Use Disorder) Counselor	AZ
4	104100000X	Social Worker

General Provider Information

NPI Number	:	1992495188
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHERITA WALKER

Provider Business Mailing Address
First Line	:	7776 S POINTE PKWY W STE 260
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85044-5407
Country	:	US
Telephone Number	:	702-715-6178
Fax Number	:	602-431-3181

Provider Business Practice Location Address
First Line	:	7776 S POINTE PKWY W STE 260
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85044-5407
Country	:	US
Telephone Number	:	702-715-6178
Fax Number	:	602-431-3181

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

Provider Enumeration Date	:	05/10/2023
Last Update Date	:	05/10/2023

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Directions to “ SHERITA WALKER ” Practice Location

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