| Audra Walsh, Phd, Llc | |
|
1039 Park St N St Petersburg FL 33710-4317 | |
| (727) 599-3624 | |
| Not Available |
| Full Name | Audra Walsh, Phd, Llc |
|---|---|
| Speciality | Psychologist - Clinical Child & Adolescent |
| Location | 1039 Park St N, St Petersburg, Florida |
| Authorized Official Name and Position | Audra Walsh (LICENSED PSYCHOLOGIST) |
| Authorized Official Contact | 7275993624 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Audra Walsh, Phd, Llc 1039 Park St N St Petersburg FL 33710-4317 Ph: (727) 599-3624 | Audra Walsh, Phd, Llc 1039 Park St N St Petersburg FL 33710-4317 Ph: (727) 599-3624 |
| NPI Number | 1073028734 |
|---|---|
| Provider Enumeration Date | 12/04/2017 |
| Last Update Date | 12/04/2017 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1073028734 | NPI | - | NPPES |
| 1205249752 | Medicaid | FL | |
| 1477710416 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC2200X | Psychologist - Clinical Child & Adolescent | PY9148 (Florida) | Primary |
| 103TC2200X | Psychologist - Clinical Child & Adolescent | PY9751 (Florida) | Secondary |
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