Provider Demographics
NPI:1730645383
Name:WELTY, JENNY L (LLPC)
Entity Type:Individual
Prefix:
First Name:JENNY
Middle Name:L
Last Name:WELTY
Suffix:
Gender:F
Credentials:LLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8008 TERRITORIAL RD
Mailing Address - Street 2:
Mailing Address - City:MUNITH
Mailing Address - State:MI
Mailing Address - Zip Code:49259-9744
Mailing Address - Country:US
Mailing Address - Phone:989-413-7656
Mailing Address - Fax:
Practice Address - Street 1:8008 TERRITORIAL RD
Practice Address - Street 2:
Practice Address - City:MUNITH
Practice Address - State:MI
Practice Address - Zip Code:49259-9744
Practice Address - Country:US
Practice Address - Phone:989-413-7656
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-19
Last Update Date:2019-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401016740101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health