MEDICARE: CHARISSA WALSON MA, LMHC

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	60488004	WA

General Provider Information

NPI Number	:	1679721666
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARISSA WALSON MA, LMHC

Provider Business Mailing Address
First Line	:	7808 PACIFIC AVE STE 8
Second Line	:
City	:	TACOMA
State	:	WA
Zip	:	98408-7039
Country	:	US
Telephone Number	:	206-747-9604
Fax Number	:

Provider Business Practice Location Address
First Line	:	7808 PACIFIC AVE STE 8
Second Line	:
City	:	TACOMA
State	:	WA
Zip	:	98408-7039
Country	:	US
Telephone Number	:	206-747-9604
Fax Number	:	206-747-9604

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

Provider Enumeration Date	:	09/03/2008
Last Update Date	:	03/17/2018

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