Provider Demographics
NPI:1568913028
Name:WILL WALKER LCISW LLC
Entity Type:Organization
Organization Name:WILL WALKER LCISW LLC
Other - Org Name:HOURGLASS COUNSELING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:NOAH
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:JR
Authorized Official - Credentials:LCSW
Authorized Official - Phone:503-438-0266
Mailing Address - Street 1:650 NE HOLLADAY ST
Mailing Address - Street 2:SUITE 1600
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97232-2045
Mailing Address - Country:US
Mailing Address - Phone:503-438-0266
Mailing Address - Fax:
Practice Address - Street 1:650 NE HOLLADAY ST
Practice Address - Street 2:SUITE 1600
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232-2045
Practice Address - Country:US
Practice Address - Phone:503-438-0266
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-20
Last Update Date:2017-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR124827296251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health