Provider Demographics
NPI:1225808355
Name:WALKER, MILES JARROD (LPC, LCDC)
Entity Type:Individual
Prefix:MR
First Name:MILES
Middle Name:JARROD
Last Name:WALKER
Suffix:
Gender:M
Credentials:LPC, LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8602 LORALINDA DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78753-5862
Mailing Address - Country:US
Mailing Address - Phone:830-377-9677
Mailing Address - Fax:
Practice Address - Street 1:8602 LORALINDA DR
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78753-5862
Practice Address - Country:US
Practice Address - Phone:830-377-9677
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-09
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX85888101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health