Provider Demographics
NPI:1699389270
Name:WELCH, SHANNON CASEY
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:CASEY
Last Name:WELCH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:547 UREN ST
Mailing Address - Street 2:
Mailing Address - City:NEVADA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95959-2334
Mailing Address - Country:US
Mailing Address - Phone:510-295-2593
Mailing Address - Fax:
Practice Address - Street 1:547 UREN ST
Practice Address - Street 2:
Practice Address - City:NEVADA CITY
Practice Address - State:CA
Practice Address - Zip Code:95959-2334
Practice Address - Country:US
Practice Address - Phone:510-295-2593
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-01
Last Update Date:2023-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist