=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598405383
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WELCH THERAPY AND WELLNESS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/30/2022
-----------------------------------------------------
Last Update Date | 03/30/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 250 N ROCK RD STE 130
-----------------------------------------------------
City | WICHITA
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 67206-2261
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 620-755-9351
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10212 PAGANICA PL
-----------------------------------------------------
City | HUTCHINSON
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 67502-8927
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 620-755-9351
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SOLE MEMBER
-----------------------------------------------------
Name | MRS. MADISON WELCH
-----------------------------------------------------
Credential | MS, LMFT
-----------------------------------------------------
Telephone | 620-755-9351
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------