Provider Demographics
NPI:1952884140
Name:WELCH, MEGAN RENEE (PLMHP)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:RENEE
Last Name:WELCH
Suffix:
Gender:F
Credentials:PLMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 E 18TH ST
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68801-2304
Mailing Address - Country:US
Mailing Address - Phone:308-550-1015
Mailing Address - Fax:
Practice Address - Street 1:5807 OSBORNE DR W
Practice Address - Street 2:
Practice Address - City:HASTINGS
Practice Address - State:NE
Practice Address - Zip Code:68901-9158
Practice Address - Country:US
Practice Address - Phone:402-463-5611
Practice Address - Fax:402-463-9555
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-13
Last Update Date:2018-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE11153101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty