Provider Demographics
NPI:1679246474
Name:WALKER, WESLY JARRED (LPC)
Entity Type:Individual
Prefix:
First Name:WESLY
Middle Name:JARRED
Last Name:WALKER
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19914 LIBERTY TRAIL LN
Mailing Address - Street 2:
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77459-2283
Mailing Address - Country:US
Mailing Address - Phone:318-359-3680
Mailing Address - Fax:
Practice Address - Street 1:19914 LIBERTY TRAIL LN
Practice Address - Street 2:
Practice Address - City:MISSOURI CITY
Practice Address - State:TX
Practice Address - Zip Code:77459-2283
Practice Address - Country:US
Practice Address - Phone:318-359-3680
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-28
Last Update Date:2021-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX67764101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional