Provider Demographics
NPI:1598721920
Name:WELCH, TERESA J (MED, PSYCHOLOGIST)
Entity Type:Individual
Prefix:MS
First Name:TERESA
Middle Name:J
Last Name:WELCH
Suffix:
Gender:F
Credentials:MED, PSYCHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:965 GREEN ST
Mailing Address - Street 2:
Mailing Address - City:BELLEFONTE
Mailing Address - State:PA
Mailing Address - Zip Code:16823-2803
Mailing Address - Country:US
Mailing Address - Phone:814-357-7755
Mailing Address - Fax:678-882-3119
Practice Address - Street 1:965 GREEN ST
Practice Address - Street 2:
Practice Address - City:BELLEFONTE
Practice Address - State:PA
Practice Address - Zip Code:16823-2803
Practice Address - Country:US
Practice Address - Phone:814-357-7755
Practice Address - Fax:678-882-3119
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-25
Last Update Date:2016-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103TA0400X, 103TC2200X
PAPS-008078103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)
Not Answered103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent