Provider Demographics
NPI:1083616973
Name:WALKER, ROBERT ALAN (LCSW BCD)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:ALAN
Last Name:WALKER
Suffix:
Gender:M
Credentials:LCSW BCD
Other - Prefix:
Other - First Name:ROBERT
Other - Middle Name:ALAN
Other - Last Name:WALKER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW BCD
Mailing Address - Street 1:333 S. RYAN ST
Mailing Address - Street 2:220
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70601-5951
Mailing Address - Country:US
Mailing Address - Phone:337-478-9331
Mailing Address - Fax:337-478-9828
Practice Address - Street 1:333 S RYAN ST
Practice Address - Street 2:220
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601-5951
Practice Address - Country:US
Practice Address - Phone:337-478-9331
Practice Address - Fax:337-478-9828
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-11
Last Update Date:2007-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA974104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1116181Medicaid
LA1116181Medicaid