Provider Demographics
NPI:1831249960
Name:WELCH, ROBERT ANTHONY (PHD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:ANTHONY
Last Name:WELCH
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:518 W LAURIDSEN BLVD
Mailing Address - Street 2:
Mailing Address - City:PORT ANGELES
Mailing Address - State:WA
Mailing Address - Zip Code:98362-7511
Mailing Address - Country:US
Mailing Address - Phone:360-582-4868
Mailing Address - Fax:360-582-4800
Practice Address - Street 1:3080 LOWER ELWHA RD
Practice Address - Street 2:
Practice Address - City:PORT ANGELES
Practice Address - State:WA
Practice Address - Zip Code:98363-8411
Practice Address - Country:US
Practice Address - Phone:360-452-8471
Practice Address - Fax:360-457-8429
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2015-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA020705 LF00000963106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1980937Medicaid