Provider Demographics
NPI:1841707510
Name:WELCH, DEBRA L (BA, IADC)
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:L
Last Name:WELCH
Suffix:
Gender:F
Credentials:BA, IADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 5TH AVE STE 600
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50309-2319
Mailing Address - Country:US
Mailing Address - Phone:515-471-2319
Mailing Address - Fax:
Practice Address - Street 1:505 5TH AVE STE 600
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50309-2319
Practice Address - Country:US
Practice Address - Phone:515-471-2319
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-04
Last Update Date:2018-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA13064101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)