Provider Demographics
NPI:1528001955
Name:WALKER, SUSAN DENISE (MS, MS, LPC, LMFT)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:DENISE
Last Name:WALKER
Suffix:
Gender:F
Credentials:MS, MS, LPC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 346
Mailing Address - Street 2:
Mailing Address - City:CAVE SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:72718-0346
Mailing Address - Country:US
Mailing Address - Phone:479-366-7920
Mailing Address - Fax:
Practice Address - Street 1:322D N BLOOMINGTON ST
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:AR
Practice Address - Zip Code:72745-9136
Practice Address - Country:US
Practice Address - Phone:479-366-7920
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-14
Last Update Date:2013-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARP0403014101YP2500X
ARM0501001106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5Y019OtherBLUE SHIELD PROVIDER #