| Doctor Name: | TIKISHA WALWYN |
| NPI Number: | 1053703322 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | 67100 |
| Business Practice Address: | 12531 W Hwy 71 P3007 Bee Cave, TX - 787386640 |
| Business Phone Number: | 7139796746 |
| Business Fax Number: | |
| Mailing Address: | 12531 W Hwy 71, P3007 BEE CAVE |
| State: | TX |
| Postal Code: | 787386640 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 02/24/2015 |
| NPI Last Update Date: | 02/24/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | 67100 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | TX |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |