Provider Demographics
NPI:1992010797
Name:JERRY WALKER THERAPY SERVICES INC.
Entity Type:Organization
Organization Name:JERRY WALKER THERAPY SERVICES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC, NCC
Authorized Official - Phone:217-228-6194
Mailing Address - Street 1:3620 HARBOR LNDG
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:IL
Mailing Address - Zip Code:62305-8626
Mailing Address - Country:US
Mailing Address - Phone:217-228-6194
Mailing Address - Fax:217-228-6194
Practice Address - Street 1:4531 MAINE ST STE E
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:IL
Practice Address - Zip Code:62305-5877
Practice Address - Country:US
Practice Address - Phone:217-228-6194
Practice Address - Fax:217-228-6194
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-17
Last Update Date:2010-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty