Provider Demographics
NPI:1063169415
Name:WALSH, RODMAN D (LMFT)
Entity type:Individual
Prefix:
First Name:RODMAN
Middle Name:D
Last Name:WALSH
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2021 MARSHALLFIELD LN APT 2
Mailing Address - Street 2:
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90278-4230
Mailing Address - Country:US
Mailing Address - Phone:310-869-7782
Mailing Address - Fax:
Practice Address - Street 1:700 N PACIFIC COAST HWY STE 301
Practice Address - Street 2:
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90277-2147
Practice Address - Country:US
Practice Address - Phone:310-869-7782
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-06
Last Update Date:2022-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA130999106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist