Provider Demographics
NPI:1548368772
Name:WALSH, DEBBIE JOANNE (MA)
Entity type:Individual
Prefix:MISS
First Name:DEBBIE
Middle Name:JOANNE
Last Name:WALSH
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:DEBORAH
Other - Middle Name:JOANNE
Other - Last Name:WALSH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:768 PLEASANT VALLEY ROAD
Mailing Address - Street 2:
Mailing Address - City:DIAMOND SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:95619
Mailing Address - Country:US
Mailing Address - Phone:530-621-9800
Mailing Address - Fax:530-621-9804
Practice Address - Street 1:768 PLEASANT VALLEY ROAD
Practice Address - Street 2:
Practice Address - City:DIAMOND SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:95619
Practice Address - Country:US
Practice Address - Phone:530-621-9800
Practice Address - Fax:530-621-9804
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA37062106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist