Healthcare Provider Details

I. General information

NPI: 1114943297
Provider Name (Legal Business Name): GARY R WELCH LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 S LOOP 256 SUITE 124
PALESTINE TX
75801-5932
US

IV. Provider business mailing address

2000 S LOOP 256 SUITE 124
PALESTINE TX
75801-5932
US

V. Phone/Fax

Practice location:
  • Phone: 903-723-9006
  • Fax: 903-723-1537
Mailing address:
  • Phone: 903-723-9006
  • Fax: 903-723-1537

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number37312
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: