Provider Demographics
NPI:1770724288
Name:WELCH, JUDY (PSYD)
Entity type:Individual
Prefix:DR
First Name:JUDY
Middle Name:
Last Name:WELCH
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:509 MARIN STREET
Mailing Address - Street 2:SUITE 234
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91360-4321
Mailing Address - Country:US
Mailing Address - Phone:805-373-1813
Mailing Address - Fax:805-492-4975
Practice Address - Street 1:509 MARIN STREET
Practice Address - Street 2:SUITE 234
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360-4321
Practice Address - Country:US
Practice Address - Phone:805-373-1813
Practice Address - Fax:805-492-4975
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-12
Last Update Date:2009-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALEP2016103T00000X
CAMFT15020106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No103T00000XBehavioral Health & Social Service ProvidersPsychologist