Provider Demographics
NPI:1508505678
Name:WALKER, LA'SHAE D (LAC-22910)
Entity type:Individual
Prefix:
First Name:LA'SHAE
Middle Name:D
Last Name:WALKER
Suffix:
Gender:F
Credentials:LAC-22910
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:483 W SEED FARM RD BLDG 4
Mailing Address - Street 2:
Mailing Address - City:SACATON
Mailing Address - State:AZ
Mailing Address - Zip Code:85147-5000
Mailing Address - Country:US
Mailing Address - Phone:602-528-7100
Mailing Address - Fax:
Practice Address - Street 1:483 W SEED FARM RD BLDG 4
Practice Address - Street 2:
Practice Address - City:SACATON
Practice Address - State:AZ
Practice Address - Zip Code:85147-5000
Practice Address - Country:US
Practice Address - Phone:602-528-7100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-27
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLAC22910101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health