Provider Demographics
NPI:1407636129
Name:WALKER, KENNETH R (LPC ASSOCIATE)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:R
Last Name:WALKER
Suffix:
Gender:M
Credentials:LPC ASSOCIATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1033 MARIETTA LN
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:TX
Mailing Address - Zip Code:76227-1260
Mailing Address - Country:US
Mailing Address - Phone:469-213-7573
Mailing Address - Fax:
Practice Address - Street 1:1033 MARIETTA LN
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:TX
Practice Address - Zip Code:76227-1260
Practice Address - Country:US
Practice Address - Phone:469-213-7573
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-02
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX91396101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional