Provider Demographics
NPI:1457608549
Name:WELCH, NICOLE K (AA)
Entity Type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:K
Last Name:WELCH
Suffix:
Gender:F
Credentials:AA
Other - Prefix:MS
Other - First Name:NICOLE
Other - Middle Name:K
Other - Last Name:LEIGHTNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4601 E R ST
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98404-4521
Mailing Address - Country:US
Mailing Address - Phone:253-230-8357
Mailing Address - Fax:
Practice Address - Street 1:9330 59TH AVE SW
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-2858
Practice Address - Country:US
Practice Address - Phone:253-581-7020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-08
Last Update Date:2012-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health