Basic Information
Provider Information
NPI: 1922777663
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: WALKER
FirstName: HARLOW
MiddleName: H
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 226
Address2:  
City: GAMBIER
State: OH
PostalCode: 430220226
CountryCode: US
TelephoneNumber: 7403924151
FaxNumber:  
Practice Location
Address1: 106 STARRET ST STE 100
Address2:  
City: LANCASTER
State: OH
PostalCode: 431303993
CountryCode: US
TelephoneNumber: 7406870042
FaxNumber:  
Other Information
ProviderEnumerationDate: 09/07/2021
LastUpdateDate: 09/07/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 09/07/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
101YM0800X  Y Behavioral Health & Social Service ProvidersCounselorMental Health

No ID Information.


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