Provider Demographics
NPI:1518397355
Name:WALKER, BRIAN (LCPC)
Entity type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:
Last Name:WALKER
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:BRIAN
Other - Middle Name:
Other - Last Name:MOUNT-WALKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCPC
Mailing Address - Street 1:6394 E CANYON CROSSING DR
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83687-5541
Mailing Address - Country:US
Mailing Address - Phone:208-501-6813
Mailing Address - Fax:
Practice Address - Street 1:915 PARKCENTRE WAY
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83651-1745
Practice Address - Country:US
Practice Address - Phone:208-442-7791
Practice Address - Fax:208-442-7792
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-14
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLPC-5412101YM0800X
IDLCPC-6183101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health