Provider Demographics
NPI:1639476500
Name:WALSH, AMELIA JENKINS (LMFT)
Entity Type:Individual
Prefix:
First Name:AMELIA
Middle Name:JENKINS
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 1:1377 COPELAND FALLS RD
Mailing Address - Street 2:
Mailing Address - City:SEVERANCE
Mailing Address - State:CO
Mailing Address - Zip Code:80550-2872
Mailing Address - Country:US
Mailing Address - Phone:949-433-2319
Mailing Address - Fax:
Practice Address - Street 1:3938 JOHN F KENNEDY PKWY UNIT 11F
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-3087
Practice Address - Country:US
Practice Address - Phone:949-433-2319
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-11
Last Update Date:2022-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO367106H00000X
CA33271106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist