Provider Demographics
NPI:1922668367
Name:WALKER, STEPHANIE (LPCC)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:WALKER
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1507 DELLWOOD DR
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40216-4031
Mailing Address - Country:US
Mailing Address - Phone:502-553-3391
Mailing Address - Fax:
Practice Address - Street 1:1507 DELLWOOD DR
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40216-4031
Practice Address - Country:US
Practice Address - Phone:502-553-3391
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-18
Last Update Date:2019-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY103023101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty