Provider Demographics
NPI:1588090542
Name:WALKER, SEAN PAUL (BA)
Entity type:Individual
Prefix:MR
First Name:SEAN PAUL
Middle Name:
Last Name:WALKER
Suffix:
Gender:M
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:947 COLE AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90038-2610
Mailing Address - Country:US
Mailing Address - Phone:323-871-4650
Mailing Address - Fax:323-463-8141
Practice Address - Street 1:1501 HUGHES WAY
Practice Address - Street 2:SUIT 150
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90810-1876
Practice Address - Country:US
Practice Address - Phone:310-221-6336
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-23
Last Update Date:2021-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA225400000X171M00000X
CA104324106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No171M00000XOther Service ProvidersCase Manager/Care Coordinator