MEDICARE: MR. CHAD THOMAS WELCH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	178.011128	IL
2	101YP2500X	Professional Counselor	180010931	IL

General Provider Information

NPI Number	:	1861869620
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. CHAD THOMAS WELCH

Provider Business Mailing Address
First Line	:	4254 BASSEN DR
Second Line	:
City	:	SWANSEA
State	:	IL
Zip	:	62226-7910
Country	:	US
Telephone Number	:	618-558-0671
Fax Number	:

Provider Business Practice Location Address
First Line	:	4509 N ILLINOIS ST STE 5
Second Line	:
City	:	SWANSEA
State	:	IL
Zip	:	62226-1524
Country	:	US
Telephone Number	:	314-884-1947
Fax Number	:	314-408-2355

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/27/2015
Last Update Date	:	03/06/2024

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