Provider Demographics
NPI:1306067897
Name:WALKER, MICHELLE L (LMFT)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:L
Last Name:WALKER
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1653 MENTONE AVE
Mailing Address - Street 2:
Mailing Address - City:GROVER BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:93433-2908
Mailing Address - Country:US
Mailing Address - Phone:805-748-2738
Mailing Address - Fax:
Practice Address - Street 1:1653 MENTONE AVE
Practice Address - Street 2:
Practice Address - City:GROVER BEACH
Practice Address - State:CA
Practice Address - Zip Code:93433-2908
Practice Address - Country:US
Practice Address - Phone:180-574-8273
Practice Address - Fax:805-925-9706
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA112859106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA50361Medicaid