Provider Demographics
NPI:1932233889
Name:WELTER, MICHAEL DALE (MA, LMFT)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:DALE
Last Name:WELTER
Suffix:
Gender:M
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8901 ASH AVE
Mailing Address - Street 2:
Mailing Address - City:PEWEE VALLEY
Mailing Address - State:KY
Mailing Address - Zip Code:40056-9016
Mailing Address - Country:US
Mailing Address - Phone:502-241-3102
Mailing Address - Fax:
Practice Address - Street 1:6105 OUTER LOOP
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40219-4162
Practice Address - Country:US
Practice Address - Phone:502-969-7654
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0567106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist