Provider Demographics
NPI:1962638387
Name:WALSH, ALICIA (MS, LMFT)
Entity Type:Individual
Prefix:MS
First Name:ALICIA
Middle Name:
Last Name:WALSH
Suffix:
Gender:F
Credentials:MS, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6280 AMBER LAKE AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92119-3415
Mailing Address - Country:US
Mailing Address - Phone:619-398-2894
Mailing Address - Fax:
Practice Address - Street 1:6280 AMBER LAKE AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92119-3415
Practice Address - Country:US
Practice Address - Phone:619-398-2894
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-01
Last Update Date:2021-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60269764106H00000X
TX203770106H00000X
CA49263106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist