Provider Demographics
NPI:1467646117
Name:WELCH, JESSICA BOUGIE (MS, LMFT)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:BOUGIE
Last Name:WELCH
Suffix:
Gender:F
Credentials:MS, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HONEOYE FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:14472-1067
Mailing Address - Country:US
Mailing Address - Phone:585-210-9565
Mailing Address - Fax:
Practice Address - Street 1:61 N MAIN ST
Practice Address - Street 2:
Practice Address - City:HONEOYE FALLS
Practice Address - State:NY
Practice Address - Zip Code:14472-1067
Practice Address - Country:US
Practice Address - Phone:585-210-9565
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-05
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY01198106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist