Healthcare Provider Details

I. General information

NPI: 1922112671
Provider Name (Legal Business Name): THOMAS M WELSH PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2006
Last Update Date: 01/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 W CENTRAL AVE
PETAL MS
39465-2016
US

IV. Provider business mailing address

4190 DUMAINE ST
NEW ORLEANS LA
70119-3748
US

V. Phone/Fax

Practice location:
  • Phone: 504-450-5580
  • Fax: 504-309-6869
Mailing address:
  • Phone: 504-450-5580
  • Fax: 504-309-6869

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number881
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number36-603
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: