MEDICARE: DR. MARTHA WALCH PH.D

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	103TC0700X	Clinical Psychologist	23379	TX
2	103T00000X	Psychologist	23379	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1285615005	OTHER		NPI

General Provider Information

NPI Number	:	1285615005
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARTHA WALCH PH.D

Provider Business Mailing Address
First Line	:	2313 LOCKHILL SELMA RD STE 208
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78230-3007
Country	:	US
Telephone Number	:	210-446-7049
Fax Number	:

Provider Business Practice Location Address
First Line	:	6800 PARK TEN BLVD STE 212NORTH
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78213-4211
Country	:	US
Telephone Number	:	210-446-7049
Fax Number	:

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

Provider Enumeration Date	:	11/09/2005
Last Update Date	:	06/11/2019

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Directions to “ DR. MARTHA WALCH PH.D” Practice Location

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