Provider Demographics
NPI:1205527256
Name:WELCH, OWEN ANDREW
Entity type:Individual
Prefix:
First Name:OWEN
Middle Name:ANDREW
Last Name:WELCH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:170 S OAKLAND AVE
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91101-2561
Mailing Address - Country:US
Mailing Address - Phone:818-242-8403
Mailing Address - Fax:818-242-3187
Practice Address - Street 1:170 S OAKLAND AVE
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101-2561
Practice Address - Country:US
Practice Address - Phone:818-242-8403
Practice Address - Fax:818-242-3187
Is Sole Proprietor?:No
Enumeration Date:2023-05-18
Last Update Date:2024-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CA149663106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program