Provider Demographics
NPI:1790575934
Name:WALSH, KENDRA T
Entity type:Individual
Prefix:
First Name:KENDRA
Middle Name:T
Last Name:WALSH
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1911 MARIGOLD TRL NW
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32907-8170
Mailing Address - Country:US
Mailing Address - Phone:702-232-0673
Mailing Address - Fax:
Practice Address - Street 1:2550 PALM BAY RD NE STE 111
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32905-3565
Practice Address - Country:US
Practice Address - Phone:321-206-6560
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-09
Last Update Date:2025-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health