Provider Demographics
NPI:1265056741
Name:WALKER, MARK EDWARDS
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:EDWARDS
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 1:1176 E WARNER RD STE 216
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85296-3069
Mailing Address - Country:US
Mailing Address - Phone:480-601-4940
Mailing Address - Fax:
Practice Address - Street 1:1176 E WARNER RD STE 216
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85296-3069
Practice Address - Country:US
Practice Address - Phone:480-601-4940
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-01
Last Update Date:2020-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical