Provider Demographics
NPI:1629748041
Name:WALTON-CLEMONS, TEMIKA (LPC)
Entity Type:Individual
Prefix:
First Name:TEMIKA
Middle Name:
Last Name:WALTON-CLEMONS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:534 1ST ST STE A
Mailing Address - Street 2:
Mailing Address - City:CRETE
Mailing Address - State:IL
Mailing Address - Zip Code:60417-2153
Mailing Address - Country:US
Mailing Address - Phone:708-880-7747
Mailing Address - Fax:708-880-7787
Practice Address - Street 1:534 1ST ST STE A
Practice Address - Street 2:
Practice Address - City:CRETE
Practice Address - State:IL
Practice Address - Zip Code:60417-2153
Practice Address - Country:US
Practice Address - Phone:708-880-7747
Practice Address - Fax:708-880-7787
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-16
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178014090101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional