Provider Demographics
NPI:1912055146
Name:WALSH, KRISTI LYNNE (PHD)
Entity Type:Individual
Prefix:DR
First Name:KRISTI
Middle Name:LYNNE
Last Name:WALSH
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:911 E COLORADO BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91106-1773
Mailing Address - Country:US
Mailing Address - Phone:626-755-0042
Mailing Address - Fax:
Practice Address - Street 1:911 E COLORADO BLVD STE 200
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91106-1773
Practice Address - Country:US
Practice Address - Phone:626-755-0042
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT25211106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist