Provider Demographics
NPI:1760808661
Name:WALKER, VIVIAN JOYCE
Entity Type:Individual
Prefix:
First Name:VIVIAN
Middle Name:JOYCE
Last Name:WALKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2190 21ST ST
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77706-2955
Mailing Address - Country:US
Mailing Address - Phone:409-767-1754
Mailing Address - Fax:409-892-1088
Practice Address - Street 1:2190 21ST ST
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77706-2955
Practice Address - Country:US
Practice Address - Phone:409-767-1754
Practice Address - Fax:409-892-1088
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-16
Last Update Date:2014-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX103TM1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities