Provider Demographics
NPI:1679116529
Name:ALLIANCE FOR TELEPSYCHIATRY
Entity Type:Organization
Organization Name:ALLIANCE FOR TELEPSYCHIATRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:WELKE
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:747-998-0394
Mailing Address - Street 1:14860 ROSCOE BLVD
Mailing Address - Street 2:
Mailing Address - City:PANORAMA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91402
Mailing Address - Country:US
Mailing Address - Phone:747-998-0394
Mailing Address - Fax:747-998-0383
Practice Address - Street 1:8425 BALM ST
Practice Address - Street 2:
Practice Address - City:WEEKI WACHEE
Practice Address - State:FL
Practice Address - Zip Code:34607
Practice Address - Country:US
Practice Address - Phone:352-364-9401
Practice Address - Fax:352-293-4988
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-23
Last Update Date:2019-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty