Provider Demographics
NPI:1255714044
Name:WALSH, DANA ROSE (MFT)
Entity type:Individual
Prefix:
First Name:DANA
Middle Name:ROSE
Last Name:WALSH
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1655 N CALIFORNIA BLVD
Mailing Address - Street 2:APT 312
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94596
Mailing Address - Country:US
Mailing Address - Phone:925-817-9932
Mailing Address - Fax:
Practice Address - Street 1:1655 N CALIFORNIA BLVD
Practice Address - Street 2:APT 312
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94596-4463
Practice Address - Country:US
Practice Address - Phone:925-817-9932
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-30
Last Update Date:2015-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86585106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist