Provider Demographics
NPI:1871797423
Name:WALKER, JERRI S (LMHC)
Entity type:Individual
Prefix:
First Name:JERRI
Middle Name:S
Last Name:WALKER
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1040 W GREAT BASIN DR
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-3648
Mailing Address - Country:US
Mailing Address - Phone:208-887-3620
Mailing Address - Fax:
Practice Address - Street 1:1040 W GREAT BASIN DR
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-3648
Practice Address - Country:US
Practice Address - Phone:208-887-3620
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH2927101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health