Provider Demographics
NPI:1659515880
Name:NATIONAL TRAUMA & ADDICTION INSTITUTE
Entity Type:Organization
Organization Name:NATIONAL TRAUMA & ADDICTION INSTITUTE
Other - Org Name:DR. HEATHER WELKER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:M
Authorized Official - Middle Name:HEATHER
Authorized Official - Last Name:WELKER
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:417-880-3448
Mailing Address - Street 1:2107 E BERKELEY ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-3336
Mailing Address - Country:US
Mailing Address - Phone:417-880-3448
Mailing Address - Fax:
Practice Address - Street 1:725 W BATTLEFIELD ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65807-4125
Practice Address - Country:US
Practice Address - Phone:417-880-3448
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-01
Last Update Date:2009-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO01871251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1437118296Medicaid