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Organization
JR'S TRAUMA CARE INITIATIVE
Active
Organization
JR'S TRAUMA CARE INITIATIVE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CHARLES ELMER WALKER LMFT (DIRECTOR OF MENTAL HEALTH)
(619) 330-7569
Entity
Organization
Contact information
Practice address
1665 PRECISION PARK LN STE H, SAN YSIDRO, CA 92173-1348
(619) 330-7569
Mailing address
654 E SAN YSIDRO BLVD UNIT 483, SAN YSIDRO, CA 92173-3151
(619) 330-7569
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
1041C0700X
Clinical Social Worker
—
—
106H00000X
Marriage & Family Therapist
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
Other
Enumeration date
05/20/2021
Last updated
05/20/2021
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