Provider Demographics
NPI:1316209646
Name:WALKER, CRYSTAL ROXANNE (MA)
Entity Type:Individual
Prefix:MS
First Name:CRYSTAL
Middle Name:ROXANNE
Last Name:WALKER
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 GREENE RD
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:TX
Mailing Address - Zip Code:75146-6327
Mailing Address - Country:US
Mailing Address - Phone:214-689-5128
Mailing Address - Fax:214-689-5184
Practice Address - Street 1:200 GREENE RD
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:TX
Practice Address - Zip Code:75146-6327
Practice Address - Country:US
Practice Address - Phone:214-689-5128
Practice Address - Fax:214-689-5184
Is Sole Proprietor?:No
Enumeration Date:2012-06-12
Last Update Date:2014-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1316209646Medicaid