Provider Demographics
NPI:1720515984
Name:WALKER, COURTNEY TAYLOR (MFT)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:TAYLOR
Last Name:WALKER
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 N MARION ST
Mailing Address - Street 2:
Mailing Address - City:CARDINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43315-1016
Mailing Address - Country:US
Mailing Address - Phone:614-915-2363
Mailing Address - Fax:
Practice Address - Street 1:215 N MARION ST
Practice Address - Street 2:
Practice Address - City:CARDINGTON
Practice Address - State:OH
Practice Address - Zip Code:43315-1016
Practice Address - Country:US
Practice Address - Phone:614-915-2363
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-18
Last Update Date:2023-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHM.1800094106H00000X
106S00000X
OHF.2300369106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH934723678OtherOMHAS