Doctor Name: | SEAN WALSH |
NPI Number: | 1023413473 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | LPC |
License Number: | 178010387 |
Business Practice Address: | 8616 Northern Ave Rockford, IL - 611075309 |
Business Phone Number: | 8153328003 |
Business Fax Number: | |
Mailing Address: | 8616 Northern Ave, ROCKFORD |
State: | IL |
Postal Code: | 611075309 |
Phone Number: | 8153328003 |
Fax Number: | |
NPI Enumeration Date: | 10/28/2014 |
NPI Last Update Date: | 10/28/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | 178010387 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |