Doctor Name: | RUBY LEE WALKER |
NPI Number: | 1225192792 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LPCP |
License Number: | LCPC-18 |
Business Practice Address: | 1441 Parkway Dr Blackfoot, ID - 832211667 |
Business Phone Number: | 2087852600 |
Business Fax Number: | |
Mailing Address: | 1441 Parkway Dr, BLACKFOOT |
State: | ID |
Postal Code: | 832211667 |
Phone Number: | 2087852600 |
Fax Number: | |
NPI Enumeration Date: | 12/20/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | LCPC-18 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | ID |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |