Provider Demographics
NPI:1114943297
Name:WELCH, GARY R (LMSW)
Entity Type:Individual
Prefix:MR
First Name:GARY
Middle Name:R
Last Name:WELCH
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 S LOOP 256
Mailing Address - Street 2:SUITE 124
Mailing Address - City:PALESTINE
Mailing Address - State:TX
Mailing Address - Zip Code:75801-5932
Mailing Address - Country:US
Mailing Address - Phone:903-723-9006
Mailing Address - Fax:903-723-1537
Practice Address - Street 1:2000 S LOOP 256
Practice Address - Street 2:SUITE 124
Practice Address - City:PALESTINE
Practice Address - State:TX
Practice Address - Zip Code:75801-5932
Practice Address - Country:US
Practice Address - Phone:903-723-9006
Practice Address - Fax:903-723-1537
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX37312104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker