Provider Demographics
NPI:1225386600
Name:WELTER, KRISTA L (MA, MS, LPC)
Entity Type:Individual
Prefix:
First Name:KRISTA
Middle Name:L
Last Name:WELTER
Suffix:
Gender:F
Credentials:MA, MS, LPC
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 864
Mailing Address - Street 2:
Mailing Address - City:FOGELSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18051
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1011 BROOKSIDE RD STE 122
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18106-9020
Practice Address - Country:US
Practice Address - Phone:610-569-0252
Practice Address - Fax:484-460-2470
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-16
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC006457101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1029671540002Medicaid