Provider Demographics
NPI:1346799764
Name:WALKER, ROY T (PROVISIONAL LPC, PH)
Entity Type:Individual
Prefix:
First Name:ROY
Middle Name:T
Last Name:WALKER
Suffix:
Gender:M
Credentials:PROVISIONAL LPC, PH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17110 DARIEN WING
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78247
Mailing Address - Country:US
Mailing Address - Phone:210-373-0696
Mailing Address - Fax:
Practice Address - Street 1:343 LARCHMONT DR.
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78209
Practice Address - Country:US
Practice Address - Phone:210-867-9841
Practice Address - Fax:210-816-5900
Is Sole Proprietor?:No
Enumeration Date:2016-09-27
Last Update Date:2016-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX76430390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program