Provider Demographics
NPI:1083838379
Name:WALKER, MICHAEL JOSEPH
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:JOSEPH
Last Name:WALKER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:607 DIVISION ST.
Mailing Address - Street 2:
Mailing Address - City:NOME
Mailing Address - State:AK
Mailing Address - Zip Code:99762
Mailing Address - Country:US
Mailing Address - Phone:907-443-3344
Mailing Address - Fax:907-443-5915
Practice Address - Street 1:607 DIVISION ST.
Practice Address - Street 2:
Practice Address - City:NOME
Practice Address - State:AK
Practice Address - Zip Code:99762
Practice Address - Country:US
Practice Address - Phone:907-443-3344
Practice Address - Fax:907-443-5915
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2018-07-05
Deactivation Date:2007-07-17
Deactivation Code:
Reactivation Date:2008-08-08
Provider Licenses
StateLicense IDTaxonomies
CAMFC 45915106H00000X
CAMFC45915390200000X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program