Provider Demographics
NPI:1033234976
Name:G. GARY WALKER, PH.D., P.C.
Entity type:Organization
Organization Name:G. GARY WALKER, PH.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OF THE CORPORATION
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:GARY
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:806-798-8855
Mailing Address - Street 1:5203 28TH ST
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79407-3507
Mailing Address - Country:US
Mailing Address - Phone:806-798-8855
Mailing Address - Fax:806-798-8855
Practice Address - Street 1:5120 29TH DR STE D
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79407-2612
Practice Address - Country:US
Practice Address - Phone:806-798-8855
Practice Address - Fax:806-792-5715
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX192465602Medicaid
TX00252UOtherMEDICARE
TX00252UMedicare ID - Type UnspecifiedCORPORATE ID #