Provider Demographics
NPI:1386860039
Name:WALSH, KATHLEEN ALLANAUGH (LMFT)
Entity type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:ALLANAUGH
Last Name:WALSH
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2610 SE CLINTON ST
Mailing Address - Street 2:SUITE E
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97202-1273
Mailing Address - Country:US
Mailing Address - Phone:503-233-0331
Mailing Address - Fax:503-230-2813
Practice Address - Street 1:2610 SE CLINTON ST
Practice Address - Street 2:SUITE E
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97202-1273
Practice Address - Country:US
Practice Address - Phone:503-233-0331
Practice Address - Fax:503-230-2813
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORT0314106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist