Healthcare Provider Details

I. General information

NPI: 1124236518
Provider Name (Legal Business Name): JULIE M WALSH LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JULIE M MURNAME LMHC

II. Dates (important events)

Enumeration Date: 05/18/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

151 MYSTIC AVE SUITE SIX
MEDFORD MA
02155-4632
US

IV. Provider business mailing address

151 MYSTIC AVE SUITE SIX
MEDFORD MA
02155-4632
US

V. Phone/Fax

Practice location:
  • Phone: 781-396-1199
  • Fax: 781-396-1439
Mailing address:
  • Phone: 781-396-1199
  • Fax: 781-396-1439

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number4100
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: