1811256340 NPI number — MRS. CHELSEA MICHELLE WALSH M.A., LMFT

Table of content: MRS. CHELSEA MICHELLE WALSH M.A., LMFT (NPI 1811256340)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811256340 NPI number — MRS. CHELSEA MICHELLE WALSH M.A., LMFT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WALSH
Provider First Name:
CHELSEA
Provider Middle Name:
MICHELLE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
M.A., LMFT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1811256340
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/20/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 691
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RUNNING SPRINGS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92382-0691
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
909-255-1320
Provider Business Mailing Address Fax Number:
909-225-1320

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
27415 SCHOOL ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAKE ARROWHEAD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92352
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
909-255-1320
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/03/2012

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 106H00000X , with the licence number:  MFC 48426 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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