Healthcare Provider Details

I. General information

NPI: 1932280468
Provider Name (Legal Business Name): KENNETH L. WELCH PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 STATE ST
NEW ALBANY IN
47150-4911
US

IV. Provider business mailing address

1501 STATE ST
NEW ALBANY IN
47150-4911
US

V. Phone/Fax

Practice location:
  • Phone: 812-944-1550
  • Fax: 812-944-1550
Mailing address:
  • Phone: 812-944-1550
  • Fax: 812-944-1550

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number20041227A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: