Provider Demographics
NPI:1376353888
Name:WELCH, CASSIDY (MSW, LMSW)
Entity type:Individual
Prefix:
First Name:CASSIDY
Middle Name:
Last Name:WELCH
Suffix:
Gender:F
Credentials:MSW, LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2645 N VALLEY VIEW RD UNIT 9107
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86004-7209
Mailing Address - Country:US
Mailing Address - Phone:803-468-2318
Mailing Address - Fax:
Practice Address - Street 1:2384 N STEVES BLVD
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86004-6105
Practice Address - Country:US
Practice Address - Phone:928-679-8053
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-08
Last Update Date:2025-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLMSW-224101041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool