Provider Demographics
NPI:1265552103
Name:WALKER, JANICE MAE (LCPC)
Entity type:Individual
Prefix:MS
First Name:JANICE
Middle Name:MAE
Last Name:WALKER
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2065 WALTMAN ST
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-6124
Mailing Address - Country:US
Mailing Address - Phone:208-288-0040
Mailing Address - Fax:
Practice Address - Street 1:1510 ROBERT ST
Practice Address - Street 2:SUITE 101
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83705
Practice Address - Country:US
Practice Address - Phone:208-344-0844
Practice Address - Fax:208-344-0592
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-31
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID214101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health