Provider Demographics
NPI:1740346246
Name:WALKER, MARK (MS, LMHC, LPC, NCC)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:WALKER
Suffix:
Gender:M
Credentials:MS, LMHC, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1845
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98668-1845
Mailing Address - Country:US
Mailing Address - Phone:360-546-1722
Mailing Address - Fax:360-694-5372
Practice Address - Street 1:317 E 39TH ST
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98663-2233
Practice Address - Country:US
Practice Address - Phone:360-546-1722
Practice Address - Fax:360-694-5372
Is Sole Proprietor?:No
Enumeration Date:2006-12-29
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYLPC-476101YP2500X
WALH61155224101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional