Provider Demographics
NPI:1891828273
Name:WELK, TABITHA (LICSW)
Entity Type:Individual
Prefix:MRS
First Name:TABITHA
Middle Name:
Last Name:WELK
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:TABITHA
Other - Middle Name:
Other - Last Name:MORIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:119 2ND ST SW
Mailing Address - Street 2:
Mailing Address - City:RUGBY
Mailing Address - State:ND
Mailing Address - Zip Code:58368-1701
Mailing Address - Country:US
Mailing Address - Phone:701-776-2272
Mailing Address - Fax:701-343-1166
Practice Address - Street 1:119 2ND ST SW
Practice Address - Street 2:
Practice Address - City:RUGBY
Practice Address - State:ND
Practice Address - Zip Code:58368-1701
Practice Address - Country:US
Practice Address - Phone:701-776-2272
Practice Address - Fax:701-343-1166
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2023-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND43601041C0700X
ND171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND054518Medicaid