# AUDRA WALSH, PHD, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1073028734
- **Authorized official:** DR. AUDRA WALSH PHD (LICENSED PSYCHOLOGIST)
- **Authorized official phone:** (727) 599-3624

## Contact information

- **Practice address:** 1039 PARK ST N, ST PETERSBURG, FL 33710-4317
- **Practice address phone:** (727) 599-3624
- **Mailing address:** 1039 PARK ST N, ST PETERSBURG, FL 33710-4317
- **Mailing address phone:** (727) 599-3624

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 103TC2200X | Clinical Child & Adolescent Psychologist | PY9148 | FL | Yes |
| 103TC2200X | Clinical Child & Adolescent Psychologist | PY9751 | FL | — |

## Other

- **Enumeration date:** 12/04/2017
- **Last updated:** 12/04/2017

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1205249752 | — | FL |
| 05 | — | 1477710416 | — | FL |