Provider Demographics
NPI:1801053004
Name:WALKER, TORY LATRICE (MA)
Entity type:Individual
Prefix:
First Name:TORY
Middle Name:LATRICE
Last Name:WALKER
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:148 HOUGHLAND ST
Mailing Address - Street 2:
Mailing Address - City:GALLATIN
Mailing Address - State:TN
Mailing Address - Zip Code:37066-6088
Mailing Address - Country:US
Mailing Address - Phone:615-330-6829
Mailing Address - Fax:
Practice Address - Street 1:180 N BELVEDERE DR STE 6
Practice Address - Street 2:
Practice Address - City:GALLATIN
Practice Address - State:TN
Practice Address - Zip Code:37066
Practice Address - Country:US
Practice Address - Phone:615-442-0301
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-16
Last Update Date:2018-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
TN2340101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1801053004OtherCOMMERCIAL INSURANCE
TN1801053004Medicaid