Provider Demographics
NPI:1023564382
Name:WALKER, MICHAEL (LPC)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:WALKER
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:732 RED ELM LN
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76131-3552
Mailing Address - Country:US
Mailing Address - Phone:817-995-1756
Mailing Address - Fax:
Practice Address - Street 1:6012 REEF POINT LN
Practice Address - Street 2:SUITE 140
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76135
Practice Address - Country:US
Practice Address - Phone:682-312-8184
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-28
Last Update Date:2016-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX72417101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional