Provider Demographics
NPI:1619283116
Name:WALKER, JAMES JOHNATHON
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:JOHNATHON
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:PO BOX 9854
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59904-2854
Mailing Address - Country:US
Mailing Address - Phone:406-890-2132
Mailing Address - Fax:
Practice Address - Street 1:359 N MAIN ST STE 8
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-3902
Practice Address - Country:US
Practice Address - Phone:406-890-2132
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-23
Last Update Date:2024-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60099914101YM0800X
MTLCPC-LIC-62380101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1619283116Medicaid