Provider Demographics
NPI:1922112671
Name:WELSH, THOMAS M (PHD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:M
Last Name:WELSH
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4190 DUMAINE ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70119-3748
Mailing Address - Country:US
Mailing Address - Phone:504-450-5580
Mailing Address - Fax:504-309-6869
Practice Address - Street 1:206 W CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:PETAL
Practice Address - State:MS
Practice Address - Zip Code:39465-2016
Practice Address - Country:US
Practice Address - Phone:504-450-5580
Practice Address - Fax:504-309-6869
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2013-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA881103TC1900X
MS36-603103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1166634Medicaid