Provider Demographics
NPI:1932265808
Name:WALKER, MICHAEL EUGENE (PHD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:EUGENE
Last Name:WALKER
Suffix:
Gender:M
Credentials:PHD
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 4633
Mailing Address - Street 2:
Mailing Address - City:NACOGDOCHES
Mailing Address - State:TX
Mailing Address - Zip Code:75962-0001
Mailing Address - Country:US
Mailing Address - Phone:936-468-1470
Mailing Address - Fax:903-968-4381
Practice Address - Street 1:13283 STATE HIGHWAY 155 N
Practice Address - Street 2:
Practice Address - City:ORE CITY
Practice Address - State:TX
Practice Address - Zip Code:75683-3538
Practice Address - Country:US
Practice Address - Phone:903-968-4641
Practice Address - Fax:903-968-4927
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX31154103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8B8765Medicare ID - Type UnspecifiedTEXAS MEDICARE NUMBER