Provider Demographics
NPI:1417097353
Name:WALKER, DOUGLAS W (PHD)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:W
Last Name:WALKER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:308 GIROD ST
Mailing Address - Street 2:
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70448-5813
Mailing Address - Country:US
Mailing Address - Phone:985-727-7993
Mailing Address - Fax:
Practice Address - Street 1:110 VETERANS MEMORIAL BLVD STE 425
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70005-4959
Practice Address - Country:US
Practice Address - Phone:504-838-8283
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA801103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA801OtherLICENSE