Provider Demographics
NPI:1346559242
Name:TINA D. WELDY, MENTAL HEALTH COUNSELING
Entity Type:Organization
Organization Name:TINA D. WELDY, MENTAL HEALTH COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:TINA
Authorized Official - Middle Name:D
Authorized Official - Last Name:WELDY
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:574-536-7580
Mailing Address - Street 1:58308 ANDREW DR
Mailing Address - Street 2:
Mailing Address - City:GOSHEN
Mailing Address - State:IN
Mailing Address - Zip Code:46528-8663
Mailing Address - Country:US
Mailing Address - Phone:574-536-7580
Mailing Address - Fax:574-534-8462
Practice Address - Street 1:58308 ANDREW DR
Practice Address - Street 2:
Practice Address - City:GOSHEN
Practice Address - State:IN
Practice Address - Zip Code:46528-8663
Practice Address - Country:US
Practice Address - Phone:574-536-7580
Practice Address - Fax:574-534-8462
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-27
Last Update Date:2010-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39001883A101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty