Provider Demographics
NPI:1285702530
Name:WALKER, BRIAN JENS (PHD)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:JENS
Last Name:WALKER
Suffix:
Gender:M
Credentials:PHD
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 12644
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85732-2644
Mailing Address - Country:US
Mailing Address - Phone:520-747-0821
Mailing Address - Fax:520-790-5175
Practice Address - Street 1:5151 E. BROADWAY BOULEVARD
Practice Address - Street 2:SUITE 720
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85711-3783
Practice Address - Country:US
Practice Address - Phone:520-747-0821
Practice Address - Fax:520-790-5175
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1089101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1089OtherAZ STATE LICENSE NUMBER
AZ1089OtherAZ STATE LICENSE NUMBER