Provider Demographics
NPI:1255779476
Name:WELCHER, LAURA COURTNEY (BCBA-D)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:COURTNEY
Last Name:WELCHER
Suffix:
Gender:F
Credentials:BCBA-D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9410 HANOVER RD
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:MI
Mailing Address - Zip Code:49241-9780
Mailing Address - Country:US
Mailing Address - Phone:616-304-3042
Mailing Address - Fax:
Practice Address - Street 1:9410 HANOVER RD
Practice Address - Street 2:
Practice Address - City:HANOVER
Practice Address - State:MI
Practice Address - Zip Code:49241-9780
Practice Address - Country:US
Practice Address - Phone:616-304-3042
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-10
Last Update Date:2023-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1107356103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst