Provider Demographics
NPI:1457179384
Name:WALSH, ALICIA SUZANNE (LPC-ASSOCIATE)
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:SUZANNE
Last Name:WALSH
Suffix:
Gender:F
Credentials:LPC-ASSOCIATE
Other - Prefix:
Other - First Name:ALICIA
Other - Middle Name:SUZANNE
Other - Last Name:MIELKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11901 TOEPPERWEIN RD STE 1202
Mailing Address - Street 2:
Mailing Address - City:LIVE OAK
Mailing Address - State:TX
Mailing Address - Zip Code:78233-3159
Mailing Address - Country:US
Mailing Address - Phone:210-951-3479
Mailing Address - Fax:
Practice Address - Street 1:11901 TOEPPERWEIN RD STE 1202
Practice Address - Street 2:
Practice Address - City:LIVE OAK
Practice Address - State:TX
Practice Address - Zip Code:78233-3159
Practice Address - Country:US
Practice Address - Phone:210-951-3479
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-30
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX96719101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional