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General NPI Number Information
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NPI Number | 1750755864
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Entity Type | Individual
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Provider Name | MYA NEALIE WALSH LCSW
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Gender | Female
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Dates
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Enumeration Date | 12/01/2015
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Last Update Date | 11/12/2024
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Provider Practice Location Address
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Address Line | 195 W DAVIS ST APT 331
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City | DALLAS
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State | TX
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Zip | 75208-4429
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Country | US
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Telephone | 678-596-1619
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Fax |
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Provider Business Mailing Address
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Address Line | 315 S COLLEGE RD SUITE 100
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City | LAFAYETTE
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State | LA
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Zip | 70503-3212
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Country | US
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Telephone | 337-205-6073
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Fax | 337-264-9282
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | CSW009138
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License Number State | GA
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 67690
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License Number State | TX
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