Healthcare Provider Details

I. General information

NPI: 1194349571
Provider Name (Legal Business Name): COURTNEY LYNN WELSH PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2020
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3262 HOLIDAY CT STE 220
LA JOLLA CA
92037-1811
US

IV. Provider business mailing address

1963 4TH AVE
SAN DIEGO CA
92101-2394
US

V. Phone/Fax

Practice location:
  • Phone: 858-371-3737
  • Fax:
Mailing address:
  • Phone: 619-233-3432
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number36732
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: