Healthcare Provider Details

I. General information

NPI: 1235643719
Provider Name (Legal Business Name): CASEY WELCH LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2017
Last Update Date: 07/27/2022
Certification Date: 07/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9220 MENTOR AVE
MENTOR OH
44060-6412
US

IV. Provider business mailing address

9220 MENTOR AVE
MENTOR OH
44060-6412
US

V. Phone/Fax

Practice location:
  • Phone: 440-639-3581
  • Fax: 440-205-1009
Mailing address:
  • Phone: 440-639-3581
  • Fax: 440-205-1009

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberS.1302796
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: