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General NPI Number Information
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NPI Number | 1235881418
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Entity Type | Individual
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Provider Name | ALEXANDRA WENDI WELYCH-MILLER LCMHC
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Gender | Female
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Dates
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Enumeration Date | 01/19/2022
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Last Update Date | 01/20/2022
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Provider Practice Location Address
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Address Line | 78 S MAIN ST
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City | RUTLAND
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State | VT
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Zip | 05701-4591
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Country | US
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Telephone | 315-720-7061
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Fax |
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Provider Business Mailing Address
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Address Line | 103 DUDLEY RD
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City | MIDDLETOWN SPRINGS
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State | VT
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Zip | 05757-4029
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Country | US
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Telephone | 315-720-7061
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 0680134443
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License Number State | VT
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Taxonomy #2
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Taxonomy Code | 225600000X
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Taxonomy Name | Dance Therapist
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License Number | R-DMT-2658
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License Number State |
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