Healthcare Provider Details

I. General information

NPI: 1477899847
Provider Name (Legal Business Name): MS. JACINDA J. WALSH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/12/2012
Last Update Date: 12/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

304 NW 5TH ST PLAZA 300
OKEECHOBEE FL
34972-2565
US

IV. Provider business mailing address

1551 FORUM PL SUITE 400 D & E LEGACY
OKEECHOBEE FL
34974-8192
US

V. Phone/Fax

Practice location:
  • Phone: 863-357-8268
  • Fax:
Mailing address:
  • Phone: 561-616-8411
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: