Provider Demographics
NPI:1487255881
Name:WALKER, GERLYN DANETTE (LPC-7901)
Entity type:Individual
Prefix:
First Name:GERLYN
Middle Name:DANETTE
Last Name:WALKER
Suffix:
Gender:F
Credentials:LPC-7901
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:414 N LINCOLN AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:JEROME
Mailing Address - State:ID
Mailing Address - Zip Code:83338-2300
Mailing Address - Country:US
Mailing Address - Phone:208-536-0536
Mailing Address - Fax:
Practice Address - Street 1:414 N LINCOLN AVE STE 1
Practice Address - Street 2:
Practice Address - City:JEROME
Practice Address - State:ID
Practice Address - Zip Code:83338-2300
Practice Address - Country:US
Practice Address - Phone:208-324-5431
Practice Address - Fax:208-324-5597
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-03
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLPC-7901101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional