Provider Demographics
NPI:1053472886
Name:WELSH, JOAN R (PHD)
Entity type:Individual
Prefix:
First Name:JOAN
Middle Name:R
Last Name:WELSH
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1856 MICHAEL LN APT 1
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80526-1698
Mailing Address - Country:US
Mailing Address - Phone:970-416-0828
Mailing Address - Fax:
Practice Address - Street 1:1856 MICHAEL LN APT 1
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80526-1698
Practice Address - Country:US
Practice Address - Phone:970-416-0828
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2010-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1807103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist