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General NPI Number Information
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NPI Number | 1932233889
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Entity Type | Individual
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Provider Name | MICHAEL DALE WELTER MA, LMFT
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Gender | Male
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Dates
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Enumeration Date | 03/15/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 6105 OUTER LOOP
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City | LOUISVILLE
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State | KY
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Zip | 40219-4162
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Country | US
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Telephone | 502-969-7654
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Fax |
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Provider Business Mailing Address
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Address Line | 8901 ASH AVE
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City | PEWEE VALLEY
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State | KY
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Zip | 40056-9016
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Country | US
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Telephone | 502-241-3102
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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 | 0567
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License Number State | KY
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