Provider Demographics
NPI:1194315234
Name:WELCH, TALEATHA (LCSW)
Entity type:Individual
Prefix:
First Name:TALEATHA
Middle Name:
Last Name:WELCH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:TALEATHA
Other - Middle Name:
Other - Last Name:WELCH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:861 W WILLIAM ST
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:IL
Mailing Address - Zip Code:62522-2351
Mailing Address - Country:US
Mailing Address - Phone:217-402-4226
Mailing Address - Fax:
Practice Address - Street 1:861 W WILLIAM ST
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:IL
Practice Address - Zip Code:62522-2351
Practice Address - Country:US
Practice Address - Phone:217-402-4226
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-22
Last Update Date:2024-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL104100000X
IL149.0245351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker