Provider Demographics
NPI:1497314991
Name:MARTHA WALCH, PHD.
Entity Type:Organization
Organization Name:MARTHA WALCH, PHD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:WALCH
Authorized Official - Suffix:
Authorized Official - Credentials:PH/D
Authorized Official - Phone:210-446-7049
Mailing Address - Street 1:2313 LOCKHILL SELMA RD STE 208
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78230-3007
Mailing Address - Country:US
Mailing Address - Phone:210-446-7049
Mailing Address - Fax:
Practice Address - Street 1:6800 PARK TEN BLVD.
Practice Address - Street 2:SUITE 212 NORTH
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78213
Practice Address - Country:US
Practice Address - Phone:210-409-7049
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-08
Last Update Date:2019-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1285615005OtherNPI