Provider Demographics
NPI:1962643387
Name:WALKER, JEFFERY LAMONT (MHR, PLMHP)
Entity Type:Individual
Prefix:
First Name:JEFFERY
Middle Name:LAMONT
Last Name:WALKER
Suffix:
Gender:M
Credentials:MHR, PLMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1941 S 42ND ST STE 402B
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68105-2944
Mailing Address - Country:US
Mailing Address - Phone:402-208-0935
Mailing Address - Fax:
Practice Address - Street 1:1941 S 42ND ST STE 402B
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68105-2944
Practice Address - Country:US
Practice Address - Phone:402-208-0935
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-13
Last Update Date:2021-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE11076101YM0800X
NE8740101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health