1336283761 NPI number — RUBY JO WALKER LCSW,EMDR CERT,CHT,C

Table of content: RUBY JO WALKER LCSW,EMDR CERT,CHT,C (NPI 1336283761)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336283761 NPI number — RUBY JO WALKER LCSW,EMDR CERT,CHT,C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WALKER
Provider First Name:
RUBY JO
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCSW,EMDR CERT,CHT,C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1336283761
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/28/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
212 HILLCREST DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DURANGO
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
81301-6515
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
970-247-3421
Provider Business Mailing Address Fax Number:
970-259-2419

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2855 MAIN AVE
Provider Second Line Business Practice Location Address:
UNIT A107
Provider Business Practice Location Address City Name:
DURANGO
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
81301-5956
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
970-259-5711
Provider Business Practice Location Address Fax Number:
970-259-2419
Provider Enumeration Date:
02/18/2007

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:  989553 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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