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NPI 1639415656

NPI 1639415656 : JOSEPH WELCH M.DIV., MMFT : FAIRVIEW, TN

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General NPI Number Information
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    NPI Number           |    1639415656
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    Entity Type          |    Individual 
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    Provider Name        |    JOSEPH WELCH M.DIV., MMFT
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    Gender               |    Male 
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Dates
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    Enumeration Date     |    12/19/2012
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    Last Update Date     |    12/19/2012
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Provider Practice Location Address
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    Address Line         |    7117 COX PIKE SUITE 103
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    City                 |    FAIRVIEW
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    State                |    TN
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    Zip                  |    37062-9212
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    Country              |    US
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    Telephone            |    615-266-2367
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    Fax                  |    
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Provider Business Mailing Address
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    Address Line         |    7117 COX PIKE SUITE 103
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    City                 |    FAIRVIEW
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    State                |    TN
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    Zip                  |    37062-9212
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    Country              |    US
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    Telephone            |    615-266-2367
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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        |    106H00000X
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    Taxonomy Name        |    Marriage & Family Therapist
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    License Number       |    985
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    License Number State |    TN
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