Provider Demographics
NPI:1114214830
Name:WALSH, MICHELE L (LMFT)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:L
Last Name:WALSH
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1934
Mailing Address - Street 2:
Mailing Address - City:APOPKA
Mailing Address - State:FL
Mailing Address - Zip Code:32704-1934
Mailing Address - Country:US
Mailing Address - Phone:352-771-8996
Mailing Address - Fax:352-360-6582
Practice Address - Street 1:19826 E 5TH ST
Practice Address - Street 2:
Practice Address - City:UMATILLA
Practice Address - State:FL
Practice Address - Zip Code:32784
Practice Address - Country:US
Practice Address - Phone:352-771-8996
Practice Address - Fax:352-360-6582
Is Sole Proprietor?:No
Enumeration Date:2011-07-01
Last Update Date:2011-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT 2356106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist