Provider Demographics
NPI:1811104235
Name:WALKER, BRUCE W (PHD, LPC, LMFT)
Entity type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:W
Last Name:WALKER
Suffix:
Gender:M
Credentials:PHD, LPC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11615 ANGUS RD
Mailing Address - Street 2:SUITE 218
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-4078
Mailing Address - Country:US
Mailing Address - Phone:512-492-6200
Mailing Address - Fax:512-492-6201
Practice Address - Street 1:11615 ANGUS RD
Practice Address - Street 2:SUITE 218
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-4078
Practice Address - Country:US
Practice Address - Phone:512-492-6200
Practice Address - Fax:512-492-6201
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP1600X
TX10869101YP2500X
TX3576106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist