Provider Demographics
NPI:1497009963
Name:WALSH, THOMAS DANIEL
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:DANIEL
Last Name:WALSH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10313 SW 69TH AVE
Mailing Address - Street 2:
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97223-9103
Mailing Address - Country:US
Mailing Address - Phone:503-726-3698
Mailing Address - Fax:503-726-3699
Practice Address - Street 1:10313 SW 69TH AVE
Practice Address - Street 2:
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-9103
Practice Address - Country:US
Practice Address - Phone:503-726-3698
Practice Address - Fax:503-726-3699
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-05
Last Update Date:2012-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health