Provider Demographics
NPI:1861851354
Name:NELSIE WALKER, PA
Entity Type:Organization
Organization Name:NELSIE WALKER, PA
Other - Org Name:N/A
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:NELSIE
Authorized Official - Middle Name:ENEIDA
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC, CAP, DOT-SAP
Authorized Official - Phone:941-812-3977
Mailing Address - Street 1:5726 CORTEZ RD W
Mailing Address - Street 2:A-1
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34210-2701
Mailing Address - Country:US
Mailing Address - Phone:941-812-3977
Mailing Address - Fax:941-795-0181
Practice Address - Street 1:3501 CORTEZ RD W
Practice Address - Street 2:MAIN LOBBY
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34210-3104
Practice Address - Country:US
Practice Address - Phone:941-795-7330
Practice Address - Fax:941-795-0181
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-12
Last Update Date:2016-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCAP #1489101YA0400X
FLLMHC #0003538101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty