Healthcare Provider Details

I. General information

NPI: 1568925675
Provider Name (Legal Business Name): ALLISON WALSH LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/08/2019
Last Update Date: 03/03/2021
Certification Date: 03/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 MARKET ST
VERMILLION SD
57069-3037
US

IV. Provider business mailing address

21 MARKET ST
VERMILLION SD
57069-3037
US

V. Phone/Fax

Practice location:
  • Phone: 605-670-1040
  • Fax: 605-679-6603
Mailing address:
  • Phone: 605-670-1040
  • Fax: 605-679-6603

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPCMH30566
License Number StateSD
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC20341
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: