Basic Information
| Provider Information | |||||||||
| NPI: | 1164610416 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WALKER | ||||||||
| FirstName: | AL | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MS COUSELING | ||||||||
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| Mailing Information | |||||||||
| Address1: | 103 D STREET | ||||||||
| Address2: | |||||||||
| City: | MARYSVILLE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 95901 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9164735764 | ||||||||
| FaxNumber: | 9164735766 | ||||||||
| Practice Location | |||||||||
| Address1: | 103 D STREET | ||||||||
| Address2: | |||||||||
| City: | MARYSVILLE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 95901 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9164735764 | ||||||||
| FaxNumber: | 9164735766 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/11/2007 | ||||||||
| LastUpdateDate: | 12/21/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 390200000X | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.