Healthcare Provider Details

I. General information

NPI: 1184365033
Provider Name (Legal Business Name): AMBER DAWN WELSH LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2022
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

429 N UNION AVE
SHAWNEE OK
74801-7064
US

IV. Provider business mailing address

16748 CROSSLIN RD
SHAWNEE OK
74801-9707
US

V. Phone/Fax

Practice location:
  • Phone: 405-275-1844
  • Fax: 405-275-1124
Mailing address:
  • Phone: 817-805-0617
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number21765
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: