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NPI Code Detail

MEDICARE: THOMAS EUGENE WALSH

MEDICARE: THOMAS EUGENE WALSH
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
1101YA0400XAddiction (Substance Use Disorder) CounselorTEMPORARY-ADCMN

General Provider Information

NPI Number : 1427268978
Entity Type Code : Individual
Provider Name (Legal Business Name) : THOMAS EUGENE WALSH
Provider Business Mailing Address
First Line : 19816 COUNTY ROAD 8
Second Line :
City : GLENWOOD
State : MN
Zip : 56334-2218
Country : US
Telephone Number : 132-027-8327
Fax Number :
Provider Business Practice Location Address
First Line : 222 9TH AVE W
Second Line :
City : ALEXANDRIA
State : MN
Zip : 56308-2221
Country : US
Telephone Number : 132-076-3391
Fax Number : 132-076-3662
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/23/2007
Last Update Date : 07/08/2007

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Directions to “ THOMAS EUGENE WALSH ” Practice Location

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