Provider Demographics
NPI:1629444351
Name:STUART-WALKER, ADAM ELIAS (MA, LPC)
Entity Type:Individual
Prefix:MR
First Name:ADAM
Middle Name:ELIAS
Last Name:STUART-WALKER
Suffix:
Gender:M
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1816 E 17TH ST
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82001-5010
Mailing Address - Country:US
Mailing Address - Phone:307-426-4204
Mailing Address - Fax:
Practice Address - Street 1:1816 E 17TH ST
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82001-5010
Practice Address - Country:US
Practice Address - Phone:307-426-4204
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-17
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYPPC101YP2500X
WYLPC-1744101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY142603600Medicaid