Provider Demographics
NPI:1821555368
Name:WALSH, JAMES QUENTIN (LCSW)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:QUENTIN
Last Name:WALSH
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:MR
Other - First Name:JAMES
Other - Middle Name:QUENTIN
Other - Last Name:WALSH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:1850 W REPUBLIC RD
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65807-5730
Mailing Address - Country:US
Mailing Address - Phone:844-501-8387
Mailing Address - Fax:417-891-4981
Practice Address - Street 1:1850 W REPUBLIC RD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65807-5730
Practice Address - Country:US
Practice Address - Phone:844-501-8387
Practice Address - Fax:417-891-4981
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-20
Last Update Date:2019-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20180122861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical