Provider Demographics
NPI:1831251966
Name:WALSH, NANCY (MFT)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:
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:PO BOX 985
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93406-0985
Mailing Address - Country:US
Mailing Address - Phone:805-781-9530
Mailing Address - Fax:805-784-0486
Practice Address - Street 1:1190 MARSH ST
Practice Address - Street 2:SUITE C
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-3332
Practice Address - Country:US
Practice Address - Phone:805-781-9530
Practice Address - Fax:805-784-0486
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC39934106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist