Provider Demographics
NPI:1699887315
Name:WALSH, JOHN
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:
Last Name:WALSH
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:JOHN
Other - Middle Name:
Other - Last Name:WALSH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMHC
Mailing Address - Street 1:5101 MAGNOLIA BAY CIR
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33418-6734
Mailing Address - Country:US
Mailing Address - Phone:561-644-2100
Mailing Address - Fax:561-630-9303
Practice Address - Street 1:5101 MAGNOLIA BAY CIR
Practice Address - Street 2:
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33418-6734
Practice Address - Country:US
Practice Address - Phone:561-644-2100
Practice Address - Fax:561-630-9303
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH7159101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health