Provider Demographics
NPI:1417342957
Name:WALKER, CHARLES ELMER (LMFT)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:ELMER
Last Name:WALKER
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:654 E SAN YSIDRO BLVD STE 483
Mailing Address - Street 2:
Mailing Address - City:SAN YSIDRO
Mailing Address - State:CA
Mailing Address - Zip Code:92173-3151
Mailing Address - Country:US
Mailing Address - Phone:619-330-7569
Mailing Address - Fax:
Practice Address - Street 1:1665 PRECISION PARK LN STE H
Practice Address - Street 2:
Practice Address - City:SAN YSIDRO
Practice Address - State:CA
Practice Address - Zip Code:92173-1348
Practice Address - Country:US
Practice Address - Phone:619-330-7569
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-01
Last Update Date:2022-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA111585106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist