Provider Demographics
NPI:1477720779
Name:WELCH, CHANDLER FRANKLIN (DMIN)
Entity type:Individual
Prefix:DR
First Name:CHANDLER
Middle Name:FRANKLIN
Last Name:WELCH
Suffix:
Gender:M
Credentials:DMIN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:617 PALMETTO AVE
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901-4723
Mailing Address - Country:US
Mailing Address - Phone:321-984-2849
Mailing Address - Fax:
Practice Address - Street 1:617 PALMETTO AVE
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-4723
Practice Address - Country:US
Practice Address - Phone:321-984-2849
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-15
Last Update Date:2008-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH7494101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health