Provider Demographics
NPI:1669145942
Name:WALKER, PENELOPE RACHELLE (LMHC)
Entity type:Individual
Prefix:DR
First Name:PENELOPE
Middle Name:RACHELLE
Last Name:WALKER
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:218 MARK E REED WAY UNIT 2204
Mailing Address - Street 2:
Mailing Address - City:SHELTON
Mailing Address - State:WA
Mailing Address - Zip Code:98584-5800
Mailing Address - Country:US
Mailing Address - Phone:360-490-0585
Mailing Address - Fax:
Practice Address - Street 1:8275 166TH AVE NE STE 200
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-6629
Practice Address - Country:US
Practice Address - Phone:425-869-2644
Practice Address - Fax:425-867-0930
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-31
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
WAMG61159110106H00000X
WALH61591155101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist