Provider Demographics
NPI:1154050870
Name:WELCH, HEATHER (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:WELCH
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2243 AUTUMN TRACE PKWY
Mailing Address - Street 2:
Mailing Address - City:WENTZVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63385-3067
Mailing Address - Country:US
Mailing Address - Phone:314-560-3495
Mailing Address - Fax:
Practice Address - Street 1:2243 AUTUMN TRACE PKWY
Practice Address - Street 2:
Practice Address - City:WENTZVILLE
Practice Address - State:MO
Practice Address - Zip Code:63385-3067
Practice Address - Country:US
Practice Address - Phone:314-560-3495
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-08
Last Update Date:2022-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20210360821041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical