Provider Demographics
NPI:1093002040
Name:WALKER, TERRY WAYNE
Entity Type:Individual
Prefix:MR
First Name:TERRY
Middle Name:WAYNE
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 1:1900 N GATEWAY BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93727-1622
Mailing Address - Country:US
Mailing Address - Phone:559-251-4800
Mailing Address - Fax:559-453-7827
Practice Address - Street 1:1900 N GATEWAY BLVD
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93727-1622
Practice Address - Country:US
Practice Address - Phone:559-251-4800
Practice Address - Fax:559-453-7827
Is Sole Proprietor?:No
Enumeration Date:2011-06-28
Last Update Date:2023-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
CA7555101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)