Provider Demographics
NPI:1659725307
Name:WALKER, WAYNE SCOTT
Entity Type:Individual
Prefix:
First Name:WAYNE
Middle Name:SCOTT
Last Name:WALKER
Suffix:
Gender:M
Credentials:
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 667
Mailing Address - Street 2:
Mailing Address - City:CANYON
Mailing Address - State:TX
Mailing Address - Zip Code:79015-0667
Mailing Address - Country:US
Mailing Address - Phone:806-452-8006
Mailing Address - Fax:806-452-8007
Practice Address - Street 1:6500 CANYON DR
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79109-7030
Practice Address - Country:US
Practice Address - Phone:806-452-8006
Practice Address - Fax:806-452-8007
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-19
Last Update Date:2016-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11978101YA0400X
TX202084106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)