Healthcare Provider Details

I. General information

NPI: 1144355595
Provider Name (Legal Business Name): JAMES ALBERT WELSH PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/23/2007
Last Update Date: 07/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

131 ALMA MATER CT APT A STATE COLLEGE
STATE COLLEGE PA
16803-1864
US

IV. Provider business mailing address

PO BOX 1012
STATE COLLEGE PA
16804-1012
US

V. Phone/Fax

Practice location:
  • Phone: 800-953-4437
  • Fax: 814-867-1001
Mailing address:
  • Phone: 800-953-4437
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License NumberPSO16130
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier225900100
Identifier TypeMEDICAID
Identifier StateMD
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: