Provider Demographics
NPI:1679625958
Name:WALSH, TOMMI-JAI (LCSW, LSCSW)
Entity type:Individual
Prefix:
First Name:TOMMI-JAI
Middle Name:
Last Name:WALSH
Suffix:
Gender:F
Credentials:LCSW, LSCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1609 BEAU DR
Mailing Address - Street 2:
Mailing Address - City:RAYMORE
Mailing Address - State:MO
Mailing Address - Zip Code:64083-8148
Mailing Address - Country:US
Mailing Address - Phone:816-914-1166
Mailing Address - Fax:
Practice Address - Street 1:1609 BEAU DR
Practice Address - Street 2:
Practice Address - City:RAYMORE
Practice Address - State:MO
Practice Address - Zip Code:64083-8148
Practice Address - Country:US
Practice Address - Phone:816-914-1166
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2023-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20010280961041C0700X
KS22151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical