Provider Demographics
NPI:1417396409
Name:WALKER, ELENA FAITH (MA, LPCC)
Entity Type:Individual
Prefix:
First Name:ELENA
Middle Name:FAITH
Last Name:WALKER
Suffix:
Gender:F
Credentials:MA, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3617 34TH AVE S
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55406-2734
Mailing Address - Country:US
Mailing Address - Phone:612-723-2103
Mailing Address - Fax:
Practice Address - Street 1:1061 GRAND AVE
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55105-3002
Practice Address - Country:US
Practice Address - Phone:651-212-4920
Practice Address - Fax:651-212-4795
Is Sole Proprietor?:No
Enumeration Date:2013-06-23
Last Update Date:2015-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNCC00399101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor