Provider Demographics
NPI:1740299544
Name:WALSH, RICHARD G (PHD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:G
Last Name:WALSH
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1801 AVENIDA MIMOSA
Mailing Address - Street 2:
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-7121
Mailing Address - Country:US
Mailing Address - Phone:760-436-2973
Mailing Address - Fax:
Practice Address - Street 1:2120 THIBODO COURT
Practice Address - Street 2:SUITE 230
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92083
Practice Address - Country:US
Practice Address - Phone:858-279-1223
Practice Address - Fax:760-597-4880
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC18120101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health