Provider Demographics
NPI:1053856096
Name:WALKER, JESSICA ROSE (LMHC)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:ROSE
Last Name:WALKER
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:348 PEQUIN TRL SE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87123-2174
Mailing Address - Country:US
Mailing Address - Phone:505-977-3770
Mailing Address - Fax:
Practice Address - Street 1:2716 SAN PEDRO DR NE
Practice Address - Street 2:STE D
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-3326
Practice Address - Country:US
Practice Address - Phone:505-977-3770
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-29
Last Update Date:2016-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0171421101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health