Provider Demographics
NPI:1114485356
Name:WALSH, PRINCESS (LMFT)
Entity Type:Individual
Prefix:
First Name:PRINCESS
Middle Name:
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 1:12700 INGLEWOOD AVE # 601
Mailing Address - Street 2:
Mailing Address - City:HAWTHORNE
Mailing Address - State:CA
Mailing Address - Zip Code:90250-4293
Mailing Address - Country:US
Mailing Address - Phone:818-528-5667
Mailing Address - Fax:
Practice Address - Street 1:12700 INGLEWOOD AVE # 601
Practice Address - Street 2:
Practice Address - City:HAWTHORNE
Practice Address - State:CA
Practice Address - Zip Code:90250-4293
Practice Address - Country:US
Practice Address - Phone:818-528-5667
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-06
Last Update Date:2020-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA110503101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health