=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851046270
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CHAD WELCH LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/14/2022
-----------------------------------------------------
Last Update Date | 02/14/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4509 N ILLINOIS ST STE 5
-----------------------------------------------------
City | SWANSEA
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 62226-1524
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 618-558-0671
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4509 N ILLINOIS ST STE 5
-----------------------------------------------------
City | SWANSEA
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 62226-1524
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 618-558-0671
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | CHAD WELCH
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 314-884-1947
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------