MEDICARE: MARY WALSH M.ED

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1114284965
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY WALSH M.ED

Provider Business Mailing Address
First Line	:	241 BROAD ST
Second Line	:
City	:	MONTOURSVILLE
State	:	PA
Zip	:	17754-2283
Country	:	US
Telephone Number	:	570-505-6513
Fax Number	:

Provider Business Practice Location Address
First Line	:	241 BROAD ST
Second Line	:
City	:	MONTOURSVILLE
State	:	PA
Zip	:	17754-2283
Country	:	US
Telephone Number	:	570-505-6513
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/18/2012
Last Update Date	:	04/18/2012

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