Provider Demographics
NPI:1497857452
Name:WALKER, SHIRLEY A (LMHC)
Entity type:Individual
Prefix:MS
First Name:SHIRLEY
Middle Name:A
Last Name:WALKER
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:MISS
Other - First Name:SHIRLEY
Other - Middle Name:ANN
Other - Last Name:BRIDGES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 2076
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:FL
Mailing Address - Zip Code:32693
Mailing Address - Country:US
Mailing Address - Phone:352-463-7766
Mailing Address - Fax:352-463-7245
Practice Address - Street 1:216C NORTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:FL
Practice Address - Zip Code:32693
Practice Address - Country:US
Practice Address - Phone:352-463-7766
Practice Address - Fax:352-463-7245
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH3007101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL272716OtherVALUE OPTIONS
FLZ5472OtherBLUE CROSS BLUE SHIELD