Provider Demographics
NPI:1730165689
Name:WALKER, LESLIE BRENT (MSSW)
Entity type:Individual
Prefix:MR
First Name:LESLIE
Middle Name:BRENT
Last Name:WALKER
Suffix:
Gender:M
Credentials:MSSW
Other - Prefix:MR
Other - First Name:L.
Other - Middle Name:BRENT
Other - Last Name:WALKER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSSW
Mailing Address - Street 1:4405 MALLORY LN
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76309-4743
Mailing Address - Country:US
Mailing Address - Phone:940-691-1575
Mailing Address - Fax:
Practice Address - Street 1:3410 TAFT BLVD
Practice Address - Street 2:BRIDWELL HALL #325
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76308-2036
Practice Address - Country:US
Practice Address - Phone:940-397-4503
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-21
Last Update Date:2010-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX007441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical