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General NPI Number Information
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NPI Number | 1922238682
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Entity Type | Individual
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Provider Name | JOHNNIE M WELCH LPC (MHSP), LMFT,
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Gender | Male
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Dates
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Enumeration Date | 07/15/2009
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Last Update Date | 07/15/2009
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Provider Practice Location Address
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Address Line | 330 TATE RD
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City | DYERSBURG
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State | TN
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Zip | 38024-8812
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Country | US
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Telephone | 731-287-9008
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1506
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City | DYERSBURG
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State | TN
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Zip | 38025-1506
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Country | US
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Telephone | 731-287-9008
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 244
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 839
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License Number State | TN
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Taxonomy #3
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Taxonomy Code | 101YP1600X
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Taxonomy Name | Pastoral Counselor
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License Number | 45
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License Number State | TN
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Taxonomy #4
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 839
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License Number State | TN
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Taxonomy #5
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 337
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License Number State | TN
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