Provider Demographics
NPI:1003513490
Name:WELCH-URICH, SHAYLE
Entity Type:Individual
Prefix:
First Name:SHAYLE
Middle Name:
Last Name:WELCH-URICH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19995 W RIVER RD
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:OH
Mailing Address - Zip Code:43402-9121
Mailing Address - Country:US
Mailing Address - Phone:419-577-0050
Mailing Address - Fax:
Practice Address - Street 1:19995 W RIVER RD
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:OH
Practice Address - Zip Code:43402-9121
Practice Address - Country:US
Practice Address - Phone:419-577-0050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-15
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-23-63811103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
1-23-63811OtherBEHAVIOR ANALYST CERTIFICATION BOARD