Provider Demographics
NPI:1861715732
Name:WALSH, MISTY (LPC, LPCC)
Entity type:Individual
Prefix:
First Name:MISTY
Middle Name:
Last Name:WALSH
Suffix:
Gender:F
Credentials:LPC, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1935 NW 25TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97210-2547
Mailing Address - Country:US
Mailing Address - Phone:202-725-1331
Mailing Address - Fax:503-433-3890
Practice Address - Street 1:1935 NW 25TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97210-2547
Practice Address - Country:US
Practice Address - Phone:202-725-1331
Practice Address - Fax:503-433-3890
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-08
Last Update Date:2025-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPRC14113101YP2500X
CA1743101YP2500X
ORC3818101YP2500X
GALPC005797101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional