Provider Demographics
NPI:1912784430
Name:WELCH, ALYSSA TAYLOR
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:TAYLOR
Last Name:WELCH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2048 E MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:BASTROP
Mailing Address - State:LA
Mailing Address - Zip Code:71220-4035
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2568 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:OLLA
Practice Address - State:LA
Practice Address - Zip Code:71465
Practice Address - Country:US
Practice Address - Phone:318-376-2535
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-08
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA0-23-14390106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst