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General NPI Number Information
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NPI Number | 1427089036
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Entity Type | Individual
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Provider Name | GREGORY DAVID WALSH LICSW
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Gender | Male
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Dates
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Enumeration Date | 07/05/2006
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Last Update Date | 08/11/2010
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Provider Practice Location Address
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Address Line | 1600 ARBORETUM BLVD SUITE # 211
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City | VICTORIA
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State | MN
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Zip | 55386-7705
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Country | US
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Telephone | 952-443-3970
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Fax | 952-368-3177
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Provider Business Mailing Address
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Address Line | PO BOX 82 VICTORIA MENTAL HEALTH SERVICES, LTD.
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City | VICTORIA
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State | MN
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Zip | 55386-0082
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Country | US
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Telephone | 952-443-3970
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Fax | 952-368-3177
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 9379
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 103TB0200X
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Taxonomy Name | Cognitive & Behavioral Psychologist
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License Number |
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License Number State |
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