Provider Demographics
NPI:1851518039
Name:WALKER, LISA RENEE (PSYD, LPC)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:RENEE
Last Name:WALKER
Suffix:
Gender:F
Credentials:PSYD, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 HUNT ST STE 415
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48207-3210
Mailing Address - Country:US
Mailing Address - Phone:313-403-3900
Mailing Address - Fax:
Practice Address - Street 1:2200 HUNT ST STE 415
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48207-3210
Practice Address - Country:US
Practice Address - Phone:313-403-3900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2022-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4089103T00000X
MI6401010055101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1952909558Medicaid