Provider Demographics
NPI:1144704495
Name:WALKER, ERIC PHILLIP
Entity type:Individual
Prefix:MR
First Name:ERIC
Middle Name:PHILLIP
Last Name:WALKER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13924 PANAY WAY
Mailing Address - Street 2:403
Mailing Address - City:MARINA DEL REY
Mailing Address - State:CA
Mailing Address - Zip Code:90292-6193
Mailing Address - Country:US
Mailing Address - Phone:310-498-0104
Mailing Address - Fax:
Practice Address - Street 1:3685 MOTOR AVE STE 220
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90034-5746
Practice Address - Country:US
Practice Address - Phone:310-498-0104
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-22
Last Update Date:2022-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT130352106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist