MEDICARE: MR. EDWARD WELCH LCSW

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	1041C0700X	Clinical Social Worker	C0945	MS

General Provider Information

NPI Number	:	1881865319
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. EDWARD WELCH LCSW

Provider Business Mailing Address
First Line	:	5907 LAUDERDALE TOOMSUBA RD
Second Line	:
City	:	TOOMSUBA
State	:	MS
Zip	:	39364-0515
Country	:	US
Telephone Number	:	601-679-3840
Fax Number	:	601-679-2191

Provider Business Practice Location Address
First Line	:	5907 LAUDERDALE TOOMSUBA RD
Second Line	:
City	:	TOOMSUBA
State	:	MS
Zip	:	39364-0515
Country	:	US
Telephone Number	:	601-679-3840
Fax Number	:	601-679-2191

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

Provider Enumeration Date	:	03/12/2008
Last Update Date	:	03/12/2008

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