Provider Demographics
NPI:1285615005
Name:WALCH, MARTHA (PHD)
Entity type:Individual
Prefix:DR
First Name:MARTHA
Middle Name:
Last Name:WALCH
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 1:2313 LOCKHILL SELMA RD STE 208
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78230-3007
Mailing Address - Country:US
Mailing Address - Phone:210-446-7049
Mailing Address - Fax:
Practice Address - Street 1:6800 PARK TEN BLVD STE 212NORTH
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78213-4211
Practice Address - Country:US
Practice Address - Phone:210-446-7049
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-09
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX23379103TC0700X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
1285615005OtherNPI