Provider Demographics
NPI:1679998702
Name:WELCH, TERESA (BCABA)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:
Last Name:WELCH
Suffix:
Gender:F
Credentials:BCABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4785 LAKE WATERFORD WAY W
Mailing Address - Street 2:APT#1
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901-8413
Mailing Address - Country:US
Mailing Address - Phone:407-678-8889
Mailing Address - Fax:
Practice Address - Street 1:4785 LAKE WATERFORD WAY W
Practice Address - Street 2:APT#1
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-8413
Practice Address - Country:US
Practice Address - Phone:407-678-8889
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-26
Last Update Date:2014-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst