Provider Demographics
NPI:1902025851
Name:WALSH, RYAN PATRICK (MFTINTERN)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:PATRICK
Last Name:WALSH
Suffix:
Gender:M
Credentials:MFTINTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10091 STREETER RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:AUBURN
Mailing Address - State:CA
Mailing Address - Zip Code:95602-8512
Mailing Address - Country:US
Mailing Address - Phone:530-268-1355
Mailing Address - Fax:
Practice Address - Street 1:10091 STREETER RD
Practice Address - Street 2:SUITE 1
Practice Address - City:AUBURN
Practice Address - State:CA
Practice Address - Zip Code:95602-8512
Practice Address - Country:US
Practice Address - Phone:530-268-1355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA47586106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist