Healthcare Provider Details

I. General information

NPI: 1255088779
Provider Name (Legal Business Name): RACHEL J WELCH LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/04/2022
Last Update Date: 01/16/2024
Certification Date: 01/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11166 TESSON FERRY RD STE 300
SAINT LOUIS MO
63123-6966
US

IV. Provider business mailing address

2650 OLIVE ST
SAINT LOUIS MO
63103-1489
US

V. Phone/Fax

Practice location:
  • Phone: 314-898-0102
  • Fax: 314-842-2552
Mailing address:
  • Phone: 314-371-6500
  • Fax: 314-842-2552

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2021044512
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: