Provider Demographics
NPI:1154465409
Name:WALKER, GEORGE GARY (PHD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE GARY
Middle Name:
Last Name:WALKER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:DR
Other - First Name:G.
Other - Middle Name:GARY
Other - Last Name:WALKER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:5203 28TH ST
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79407-3507
Mailing Address - Country:US
Mailing Address - Phone:806-798-8855
Mailing Address - Fax:806-798-8855
Practice Address - Street 1:5120 29TH DR STE D
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79407-2612
Practice Address - Country:US
Practice Address - Phone:806-798-8855
Practice Address - Fax:806-792-5715
Is Sole Proprietor?:No
Enumeration Date:2007-02-19
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX24803103TC0700X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX034653802Medicaid
TX034653802Medicaid
TX034653802Medicaid