Healthcare Provider Details

I. General information

NPI: 1790064228
Provider Name (Legal Business Name): CHELSEA MERCEDES WALSH-ROSENN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2011
Last Update Date: 06/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12510 VAN NUYS BLVD 201
PACOIMA CA
91331-1338
US

IV. Provider business mailing address

12510 VAN NUYS BLVD 201
PACOIMA CA
91331-1338
US

V. Phone/Fax

Practice location:
  • Phone: 626-395-7100
  • Fax:
Mailing address:
  • Phone: 626-395-7100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number68074
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: