Provider Demographics
NPI:1619735107
Name:WELCH, ELLA (MS, MFT)
Entity Type:Individual
Prefix:
First Name:ELLA
Middle Name:
Last Name:WELCH
Suffix:
Gender:F
Credentials:MS, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6410 ENTERPRISE LN STE 210
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53719-1143
Mailing Address - Country:US
Mailing Address - Phone:608-492-4352
Mailing Address - Fax:
Practice Address - Street 1:6410 ENTERPRISE LN STE 210
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53719-1143
Practice Address - Country:US
Practice Address - Phone:608-492-4352
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-08
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1044-228106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist