MEDICARE: DR. BEVERLY DOLENZ WALSH PHD

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	103T00000X	Psychologist	25992	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1578557450
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BEVERLY DOLENZ WALSH PHD

Provider Business Mailing Address
First Line	:	14034 HOOPER RD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77047-5212
Country	:	US
Telephone Number	:	713-540-1528
Fax Number	:	713-433-2339

Provider Business Practice Location Address
First Line	:	14034 HOOPER RD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77047-5212
Country	:	US
Telephone Number	:	713-540-1528
Fax Number	:	713-433-2339

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

Provider Enumeration Date	:	09/07/2005
Last Update Date	:	05/04/2011

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