Healthcare Provider Details

I. General information

NPI: 1104344977
Provider Name (Legal Business Name): KARA WALSH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2017
Last Update Date: 08/31/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6147 SUTTER AVE
CARMICHAEL CA
95608-2738
US

IV. Provider business mailing address

8975 CARRIAGE DR
GRANITE BAY CA
95746-8802
US

V. Phone/Fax

Practice location:
  • Phone: 916-971-9677
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number94962
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: