Provider Demographics
NPI:1932302403
Name:WELCH, BRYANT L (JD, PHD)
Entity Type:Individual
Prefix:DR
First Name:BRYANT
Middle Name:L
Last Name:WELCH
Suffix:
Gender:M
Credentials:JD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 SHELTER COVE LN STE 204
Mailing Address - Street 2:
Mailing Address - City:HILTON HEAD ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29928-3541
Mailing Address - Country:US
Mailing Address - Phone:843-686-2260
Mailing Address - Fax:843-341-9331
Practice Address - Street 1:19 SHELTER COVE LN STE 204
Practice Address - Street 2:
Practice Address - City:HILTON HEAD ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29928-3541
Practice Address - Country:US
Practice Address - Phone:843-686-2260
Practice Address - Fax:843-341-9331
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC000857103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical