Healthcare Provider Details

I. General information

NPI: 1902032089
Provider Name (Legal Business Name): ERIC WELSH PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2009
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

407 FONTAINE PL STE 102
RIDGELAND MS
39157-5170
US

IV. Provider business mailing address

407 FONTAINE PL STE 102
RIDGELAND MS
39157-5170
US

V. Phone/Fax

Practice location:
  • Phone: 601-946-1606
  • Fax:
Mailing address:
  • Phone: 601-946-1606
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number52909
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: