Provider Demographics
NPI:1942847868
Name:WALKER, BETHANY DAWN (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:BETHANY
Middle Name:DAWN
Last Name:WALKER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MISS
Other - First Name:BETHANY
Other - Middle Name:DAWN
Other - Last Name:RICHARDSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 6425
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75608-6425
Mailing Address - Country:US
Mailing Address - Phone:903-242-8306
Mailing Address - Fax:
Practice Address - Street 1:814 GILMER RD STE 1
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75604-3614
Practice Address - Country:US
Practice Address - Phone:903-242-8306
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-10
Last Update Date:2022-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX68319104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX68319OtherLCSW LICENSE