Provider Demographics
NPI:1639415656
Name:WELCH, JOSEPH (MDIV, MMFT)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:
Last Name:WELCH
Suffix:
Gender:M
Credentials:MDIV, MMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7117 COX PIKE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:FAIRVIEW
Mailing Address - State:TN
Mailing Address - Zip Code:37062-9212
Mailing Address - Country:US
Mailing Address - Phone:615-266-2367
Mailing Address - Fax:
Practice Address - Street 1:7117 COX PIKE
Practice Address - Street 2:SUITE 103
Practice Address - City:FAIRVIEW
Practice Address - State:TN
Practice Address - Zip Code:37062-9212
Practice Address - Country:US
Practice Address - Phone:615-266-2367
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-19
Last Update Date:2012-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN985106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist