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General NPI Number Information
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NPI Number | 1265949002
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Entity Type | Individual
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Provider Name | JILLIAN WALSH LPCA
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Gender | Female
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Dates
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Enumeration Date | 01/02/2018
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Last Update Date | 10/30/2024
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Provider Practice Location Address
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Address Line | 3500 NE MARTIN LUTHER KING JR BLVD STE 200
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City | PORTLAND
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State | OR
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Zip | 97212-2093
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Country | US
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Telephone | 503-327-8205
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Fax |
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Provider Business Mailing Address
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Address Line | 5004 N MONTANA AVE
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City | PORTLAND
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State | OR
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Zip | 97217-3768
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Country | US
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Telephone | 617-838-0570
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 221700000X
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Taxonomy Name | Art Therapist
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License Number | 22-180
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | R9087
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License Number State | OR
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Taxonomy #3
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Taxonomy Code | 221700000X
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Taxonomy Name | Art Therapist
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License Number | ART-C-10231130
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License Number State | OR
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