Basic Information
| Provider Information | |||||||||
| NPI: | 1982656831 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WALKER | ||||||||
| FirstName: | LARRY | ||||||||
| MiddleName: | DEAN | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | PH.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 850 HARVARD WAY | ||||||||
| Address2: | |||||||||
| City: | RENO | ||||||||
| State: | NV | ||||||||
| PostalCode: | 895022055 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7759825262 | ||||||||
| FaxNumber: | 7759825496 | ||||||||
| Practice Location | |||||||||
| Address1: | 85 KIRMAN AVE STE 200 | ||||||||
| Address2: | |||||||||
| City: | RENO | ||||||||
| State: | NV | ||||||||
| PostalCode: | 895021339 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7759822862 | ||||||||
| FaxNumber: | 7759822865 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/17/2006 | ||||||||
| LastUpdateDate: | 08/17/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | MH5282 | FL | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 103T00000X | PS04738-L | PA | N | Behavioral Health & Social Service Providers | Psychologist | 103T00000X | PSY22181 | CA | N | Behavioral Health & Social Service Providers | Psychologist | 103T00000X | PSY003253 | GA | N | Behavioral Health & Social Service Providers | Psychologist | 103T00000X | PY0692 | NV | Y | Behavioral Health & Social Service Providers | Psychologist |
ID Information
| ID | Type | State | Issuer | Description | 11388219 | 01 | CAQH | OTHER | 1982656831 | 05 | NV | MEDICAID |