Provider Demographics
NPI:1124368816
Name:WELSH, TIMOTHY VINCENT (LCSW)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:VINCENT
Last Name:WELSH
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 950244
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40295-0244
Mailing Address - Country:US
Mailing Address - Phone:502-953-4700
Mailing Address - Fax:502-778-3499
Practice Address - Street 1:712 E MUHAMMAD ALI BLVD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-1643
Practice Address - Country:US
Practice Address - Phone:502-568-6972
Practice Address - Fax:502-996-8309
Is Sole Proprietor?:No
Enumeration Date:2013-02-18
Last Update Date:2021-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY37401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100237940Medicaid
KYK077050Medicare PIN
KYK077055Medicare PIN
KYK077053Medicare PIN
KYK077052Medicare PIN
KY7100237940Medicaid
KYK077056Medicare PIN
KYK077054Medicare PIN