NPIMap

Organization Active NPI

Walker Therapy LLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Jackson, MS
National Provider Identifier
1598406548
Registry record updated Aug 17, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X
Legal business name
WALKER THERAPY LLC
Doing business as
Flourish Mental Wellness
Practice address
1640 Lelia Dr Ste 120
Jackson, MS 39216-4873
Phone
(601) 914-4492
Fax
(601) 914-6715
NPI assigned
Apr 5, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 17, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Ian D Walker, MS, LPC, BC-TMHNPI 1538601638
Title
Member
Phone
(601) 914-4492

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Professional CounselorGroup: 193400000X SINGLE SPECIALTY GROUP 101YP2500X
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X Primary
Psychiatric/Mental Health Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LP0808X

Addresses

Primary practice location

1640 Lelia Dr Ste 120
Jackson, MS 39216-4873

Mailing address

1640 Lelia Dr Ste 120
Jackson, MS 39216-4873

Other identifiers 1

IdentifierTypeStateIssuer
06285286MedicaidMS

Other names 1

  • Flourish Mental Wellness Doing business as

National Provider Directory

National Provider Directory

Locations

1640 Lelia Dr
Ste 120
Jackson, MS 39216
Phone (601) 914-4492

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1649116800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1660694400000",
    "number": "1598406548",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1640 LELIA DR STE 120",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392164873"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1640 LELIA DR STE 120",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392164873",
            "telephone_number": "601-914-4492",
            "fax_number": "601-914-6715"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WALKER THERAPY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-04-05",
        "last_updated": "2022-08-17",
        "certification_date": "2022-08-17",
        "status": "A",
        "authorized_official_last_name": "WALKER",
        "authorized_official_first_name": "IAN",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "601-914-4492",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MS, LPC, BC-TMH"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Professional",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "06285286",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Flourish Mental Wellness",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Flourish Mental Wellness",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Jackson, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 17, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.