Provider Demographics
NPI:1922238682
Name:WELCH, JOHNNIE M (LPC (MHSP), LMFT,)
Entity Type:Individual
Prefix:DR
First Name:JOHNNIE
Middle Name:M
Last Name:WELCH
Suffix:
Gender:M
Credentials:LPC (MHSP), LMFT,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1506
Mailing Address - Street 2:
Mailing Address - City:DYERSBURG
Mailing Address - State:TN
Mailing Address - Zip Code:38025-1506
Mailing Address - Country:US
Mailing Address - Phone:731-287-9008
Mailing Address - Fax:
Practice Address - Street 1:330 TATE RD
Practice Address - Street 2:
Practice Address - City:DYERSBURG
Practice Address - State:TN
Practice Address - Zip Code:38024-8812
Practice Address - Country:US
Practice Address - Phone:731-287-9008
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-15
Last Update Date:2009-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN244101YA0400X
TN839101YM0800X, 101YP2500X
TN45101YP1600X
TN337106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist