Provider Demographics
NPI:1477856748
Name:WALKER, LARRY WARDELL (LPC)
Entity Type:Individual
Prefix:MR
First Name:LARRY
Middle Name:WARDELL
Last Name:WALKER
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6120 TANGLEDAHL LN
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77706-2524
Mailing Address - Country:US
Mailing Address - Phone:409-350-9893
Mailing Address - Fax:
Practice Address - Street 1:6120 TANGLEDAHL LN
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77706-2524
Practice Address - Country:US
Practice Address - Phone:409-350-9893
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-08
Last Update Date:2010-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX66159101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX101YP2500XMedicaid