Healthcare Provider Details

I. General information

NPI: 1912055146
Provider Name (Legal Business Name): KRISTI LYNNE WALSH PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/05/2007
Last Update Date: 03/20/2025
Certification Date: 03/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

N70W6946 BRIDGE RD
CEDARBURG WI
53012-1814
US

IV. Provider business mailing address

911 E COLORADO BLVD STE 200
PASADENA CA
91106-1773
US

V. Phone/Fax

Practice location:
  • Phone: 805-722-5221
  • Fax:
Mailing address:
  • Phone: 626-755-0042
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFT25211
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code102L00000X
TaxonomyPsychoanalyst
License Number1471-124
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: