Provider Demographics
NPI:1912498825
Name:WELSH, STEVE THOMAS (LCSW, ACADC)
Entity Type:Individual
Prefix:
First Name:STEVE
Middle Name:THOMAS
Last Name:WELSH
Suffix:
Gender:M
Credentials:LCSW, ACADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:239 DOUMECQ RD
Mailing Address - Street 2:
Mailing Address - City:WHITE BIRD
Mailing Address - State:ID
Mailing Address - Zip Code:83554-5018
Mailing Address - Country:US
Mailing Address - Phone:208-413-1087
Mailing Address - Fax:
Practice Address - Street 1:2645 N COLE RD STE F
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-5970
Practice Address - Country:US
Practice Address - Phone:208-413-1087
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-25
Last Update Date:2023-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
ID435121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker