Provider Information for 1861715732
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MISTY WALSH LPC, LPCC
Sex: Female
NPI: 1861715732
Last Updated: 2021-01-23
Certification Date: 2021-01-23
Certification Date: 2021-01-23
Details
| Name | Value | ||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NPI | 1861715732 | ||||||||||||||||
| Enumeration Date | 2010-03-08 | ||||||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||||||
| Sole Proprietor | NO | ||||||||||||||||
| Status | Active | ||||||||||||||||
| Mailing Address | 1230 NW 12TH AVE APT 238 PORTLAND, OR 97209-3545 United States Phone: 202-725-1331 | Fax: | ||||||||||||||||
| Primary Practice Address | 1230 NW 12TH AVE APT 238 PORTLAND, OR 97209-3545 United States Phone: 202-725-1331 | Fax: | ||||||||||||||||
| Secondary Practice Address(es) | 12948 SE 155TH AVE | ||||||||||||||||
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