Provider Demographics
NPI:1700246410
Name:WELTY, WILLIAM SHAWN (LPC)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:SHAWN
Last Name:WELTY
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:MR
Other - First Name:W.
Other - Middle Name:SHAWN
Other - Last Name:WELTY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPC
Mailing Address - Street 1:PO BOX 1186
Mailing Address - Street 2:
Mailing Address - City:VERNON
Mailing Address - State:NJ
Mailing Address - Zip Code:07462-1186
Mailing Address - Country:US
Mailing Address - Phone:973-845-8120
Mailing Address - Fax:
Practice Address - Street 1:420 BOULEVARD
Practice Address - Street 2:SUITE 101
Practice Address - City:MOUNTAIN LAKES
Practice Address - State:NJ
Practice Address - Zip Code:07046-1742
Practice Address - Country:US
Practice Address - Phone:973-321-4380
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-24
Last Update Date:2020-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37LC00249300101YA0400X
NJ37PC00544300101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)