Provider Demographics
NPI:1013111723
Name:WELTON, SARAH RUTH (MSCP)
Entity Type:Individual
Prefix:MS
First Name:SARAH
Middle Name:RUTH
Last Name:WELTON
Suffix:
Gender:F
Credentials:MSCP
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 870725
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99687-0725
Mailing Address - Country:US
Mailing Address - Phone:907-373-5595
Mailing Address - Fax:907-373-9956
Practice Address - Street 1:500 N MAIN ST
Practice Address - Street 2:SUITE B
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-7019
Practice Address - Country:US
Practice Address - Phone:907-373-5585
Practice Address - Fax:907-373-5596
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK234101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional