Healthcare Provider Details

I. General information

NPI: 1083639488
Provider Name (Legal Business Name): MARY WELCH LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 11/05/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

651 N STATE ST
CARO MI
48723-1543
US

IV. Provider business mailing address

467 N STATE ST
CARO MI
48723-1539
US

V. Phone/Fax

Practice location:
  • Phone: 989-673-5700
  • Fax: 989-672-2555
Mailing address:
  • Phone: 989-672-6160
  • Fax: 989-672-5649

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801067926
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: