1366467268 NPI number — MRS. MICHELE L WALKER LCSW

Table of content: MRS. MICHELE L WALKER LCSW (NPI 1366467268)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366467268 NPI number — MRS. MICHELE L WALKER LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WALKER
Provider First Name:
MICHELE
Provider Middle Name:
L
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WALKER
Provider Other First Name:
MICHELE
Provider Other Middle Name:
L
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
LCSW
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1366467268
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/09/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2402 NORTH TIFT AVE.
Provider Second Line Business Mailing Address:
STE. 102 SOUTH GEORGIA PSYCHIATRIC AND COUNSELING CENTE
Provider Business Mailing Address City Name:
TIFTON
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
31794
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
229-387-8878
Provider Business Mailing Address Fax Number:
229-387-8881

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2402 NORTH TIFT AVE.
Provider Second Line Business Practice Location Address:
STE. 102 SOUTH GEORGIA PSYCHIATRIC AND COUNSELING CENTE
Provider Business Practice Location Address City Name:
TIFTON
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31794
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
229-387-8878
Provider Business Practice Location Address Fax Number:
229-387-8881
Provider Enumeration Date:
07/12/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  003267 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 348879000 . This is a "MAGELLAN HEALTH SERVICES" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 764550927A, B, C, D , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 52072002-01 . This is a "BLUE CROSS/BLUE SHEILD" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".