Provider Demographics
NPI:1144355595
Name:WELSH, JAMES ALBERT (PHD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:ALBERT
Last Name:WELSH
Suffix:
Gender:M
Credentials:PHD
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 1012
Mailing Address - Street 2:
Mailing Address - City:STATE COLLEGE
Mailing Address - State:PA
Mailing Address - Zip Code:16804-1012
Mailing Address - Country:US
Mailing Address - Phone:800-953-4437
Mailing Address - Fax:
Practice Address - Street 1:131 ALMA MATER CT APT A
Practice Address - Street 2:STATE COLLEGE
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16803-1864
Practice Address - Country:US
Practice Address - Phone:800-953-4437
Practice Address - Fax:814-867-1001
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2011-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPSO16130103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD225900100Medicaid
MD421797Medicare ID - Type Unspecified
MDR23079Medicare UPIN