Provider Demographics
NPI:1275788622
Name:WALSHE, SUSAN MICHELE (MS, MFT)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:MICHELE
Last Name:WALSHE
Suffix:
Gender:F
Credentials:MS, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4712 E 2ND ST # 736
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90803-5309
Mailing Address - Country:US
Mailing Address - Phone:562-480-2096
Mailing Address - Fax:562-567-0579
Practice Address - Street 1:6621 E PACIFIC COAST HWY STE 220
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90803-4239
Practice Address - Country:US
Practice Address - Phone:562-480-2096
Practice Address - Fax:562-567-0579
Is Sole Proprietor?:No
Enumeration Date:2008-11-26
Last Update Date:2018-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 45035106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist