Provider Demographics
NPI:1427709369
Name:WALKER, JASON MICHAEL
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:MICHAEL
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 1:26 BRIDLEPATH DR
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-6630
Mailing Address - Country:US
Mailing Address - Phone:731-695-7331
Mailing Address - Fax:
Practice Address - Street 1:26 BRIDLEPATH DR
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-6630
Practice Address - Country:US
Practice Address - Phone:731-695-7331
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-12
Last Update Date:2022-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA17115101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health