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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